Living with type 1 diabetes and chronic fatigue: Cognitive Behavioural Therapy (CBT) may help.

A CBT intervention conducted in the Netherlands shows promising results.

by Dr Christel Hendrieckx

This paper reports on a multicentre randomised controlled trial (RCT) examining the efficacy of Dia-Fit, a cognitive behavioural intervention (CBT) for Dutch adults with type 1 diabetes and chronic fatigue. Although not much research has been done in this area, studies have reported that up to 40% of adults with type 1 diabetes also report persistent fatigue.  Chronic fatigue is defined as ‘severe fatigue that is present for at least 6 months and with a substantial impact on daily functioning’. This is not surprising when hyperglycaemia, diabetes-related complications and somatic comorbidities could be triggers for fatigue. In addition, cognitive behavioural factors may also perpetuate fatigue.

The CBT intervention consisted of five to eight, 50 minutes face-to-face sessions, in combination with internet modules. It was individually tailored and delivered by a clinical psychologist over a five-month period.

The authors showed that fatigue severity and functional impairment significantly reduced in participants in the intervention group (n=60), compared to the wait-list control group (n=60).  HbA1c and glucose variability (i.e. average of seven measurements during two consecutive days) did not change over the trial period. Currently, there is no evidence of an association between fatigue and these two diabetes factors.

This first, explorative intervention showed promising results. However, the authors suggested that a fully web-based intervention could be a better option. The face-to-face format was a barrier to participation for many (due to time investment and travel distance). Future studies should examine the long-term effects of the intervention and mediating factors that could have contributed to the positive outcomes.

Menting J, Tack CJ,  van Bon Ac, Jansen HJ, van den Bergh JP, Mol MJTM, Goedendorp MM, Donders R, Knoop H. Web-based cognitive behavioural therapy blended with face-to-face sessions for chronic fatigue in type 1 diabetes: a multicentre randomised controlled trial. Lancet Diabetes Endocrinol, 2017;  5 (6): 448-56