Chronic fatigue and type 1 diabetes: Promising early results with cognitive behavioral therapy

The aim of this study was to examine the benefits of cognitive behavioral therapy (CBT) on chronic fatigue in patients with type 1 diabetes. Authors concluded that CBT can reduce fatigue severity and functional impairment in type 1 diabetes.

Chronic fatigue (severe fatigue for at least 6 months) is a common and bothersome occurence in patients with type 1 diabetes. It is thought that up to 40% of type 1 diabetes patients suffer from chronic fatigue. It has been suggested that fatigue is the result of unbalanced glucose (blood sugar) levels. However, many patients whp properly manage their disease continue to experience chronic fatigue. Cognitive behavioral therapy (CBT) is a type of psychological therapy that has shown to reduce chronic fatigue in other diseases. Whether it can reduce chronic fatigue in patients with type 1 diabetes has not been fully studied.

This study examined the effectiveness of CBT in reducing chronic fatigue in patients with type 1 diabetes.

120 type 1 diabetes patients were randomly assigned to either CBT or waiting list (control group). All patients suffered from chronic fatigue for at least 6 months. CBT consisted of 5 to 8 face-to-face sessions of 50 min with a therapist and web-based modules offered through an internet portal. The CBT program lasted 5 months and consisted of 8 separate modules. Fatigue severity and markers of diabetes were measured before and after intervention.

The average number of face-to-face CBT sessions was 5.4. Average time spent on the website was 5 hours and 33 minutes. Therapists rated treatment adherence with an average score of 7.4 (out of 10).

Compared with patients in the waiting list group, patients in the CBT group reported significantly lower fatigue severity at 5 months. Fatigue severity in the CBT group increased slightly between the end of intervention and 6 months after intervention. However, fatigue was still significantly reduced 6 months after the end of CBT when compared to before intervention.

The functional impairment of diabetes (impact of the disease on everyday activities) was also significantly reduced among patients treated with CBT. The size of this effect was medium. No significant differences in HbA1c levels (a measurement of average blood sugar levels over the past 3 months) or glucose variability were observed between groups.

Authors concluded that CBT may help to reduce chronic fatigue and functional impairment in type 1 diabetes.

Larger studies are needed to confirm these results.