ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
ORIGINAL ARTICLE

Fatigue is Related to Insulin Use by Acting Via Depressive Mood in Patients with Diabetes Mellitus
Diyabet Hastalarında Gözlenen Yorgunluk, İnsülin Kullanımına Bağlı Oluşan Depresif Duygudurum ile İlişkilidir
Received Date : 23 Sep 2019
Accepted Date : 22 Jan 2020
Available Online : 04 Feb 2020
Doi: 10.25179/tjem.2019-71576 - Makale Dili: EN
Turk J Endocrinol Metab 2020;24:29-37
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: Fatigue is a common symptom in diabetes mellitus. The aim of this study was to determine the factors leading to fatigue and to investigate the effect of insulin use on fatigue among the diabetic population. Material and Methods: Onehundred diabetic patients attending the diabetes clinic of Cerrahpasa Medical Faculty between October 2017-January 2018 and 42 healthy controls were evaluated in this cross-sectional study. Questionnaires including demographic and disease characteristics, Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), quality of life scale (SF-36), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI) were used. Results: Ages (47.6±14.8 and 45.7±14.1 years; p=0.47) and body mass indices (26.6±4.1 and 25.3±3.5 kg/m2; p=0.08) of 100 patients with diabetes (Type 1 Diabetes/Type 2 Diabetes= 29/71) and 42 healthy volunteers were similar. The diabetic group had worse FIS total (p=0.05), FIS psychological (p=0.04) scores and SF–36 scores compared to the healthy controls. When the patients with diabetes were divided into two groups according to insulin use and compared with healthy controls, the ESS and PSQI were similar but all FIS parameters (total p=0.005, cognitive p=0.007, physical p=0.01, psychological p=0.009) and BDI (p=0.05) were significantly worse in patients with insulin use than non-insulin and control groups. The relationship between fatigue and insulin use was independent of glycemic control and duration of diabetes but was affected by the BDI (p=0.001). Conclusion: Insulin use leads to fatigue in patients with diabetes, regardless of diabetes type, and this effect is influenced by depressive mood. Psychotherapeutic approaches prior to insulin treatment might yield fruitful results.
ÖZET
Amaç: Yorgunluk, diabetes mellitusta sık rastlanan bir semptomdur. Bu çalışmanın amacı diyabetik hastalarda yorgunluğa sebep olabilecek faktörlerin belirlenmesi ve insülin kullanımının yorgunluk üzerine olan etkisinin değerlendirilmesidir. Gereç ve Yöntemler: Bu kesitsel çalışmada, Ekim 2017-Ocak 2018 tarihleri arasında İstanbul Üniversitesi Cerrahpaşa-Cerrahpaşa Tıp Fakültesi Diyabet Polikliniğinde takip edilen 100 diyabet hastası ve 42 sağlıklı kontrol değerlendirilmiştir. Hastaların demografik ve hastalık özelliklerinin yanı sıra Yorgunluk Etki Ölçeği (YEÖ), Yorgunluk Şiddet Ölçeği (YŞÖ), Beck Depresyon Envanteri (BDE), hayat kalitesi ölçeği (SF-36), Epworth Uykululuk Ölçeği (EUÖ) ve Pittsburgh Uyku Kalitesi Ölçeği (PUKÖ) anketleri değerlendirilmiştir. Bulgular: Çalışmada değerlendirilen 100 diyabetik hastanın (Tip 1/Tip 2: 29/71) ve 42 sağlıklı gönüllünün yaşları (47,6±14,8 ve 45,7±14,1 yıl; p=0.47) ve beden kitle indeksleri (26,6±4,1 ve 25,3±3,5 kg/m2; p=0,08) benzerdi. Diyabet grubunda kontrol grubuna göre toplam YEÖ (p=0,05), psikolojik YEÖ alt grubu (p=0,04) ve SF-36 skorları daha kötü saptandı. Diyabet grubu insülin kullanımına göre 2’ye bölündüğünde, EUÖ ve PUKÖ skorları her 3 grupta benzer iken, tüm YEÖ parametreleri (toplam p=0,005; kognitif p=0,007, fiziksel p=0,01, psikolojik p=0,009) ve BDR skoru (p=0,05) insülin kullanan grupta, kullanmayanlar ve kontrol grubuna göre daha kötü saptandı. Yorgunluk ve insülin kullanımı ilişkisi, glisemik kontrol ve diyabet süresinden bağımsız, ancak BDE’den etkilenmekteydi (p=0,001). Sonuç: Diyabetli bireylerde insülin kullanımı yorgunluğa sebep olmakta ve bu etki diyabet tipinden bağımsız olarak depresif durumdan etkilenmektedir. İnsülin tedavisi başlangıcında psikoterapötik yaklaşımlar uygun olabilir.
KAYNAKLAR
  1. Singh R, Teel C, Sabus C, McGinnis P, Kluding P. Fatigue in type 2 diabetes: impact on quality of life and predictors. PloS One. 2016;11:e0165652. [Crossref]  [PubMed]  [PMC] 
  2. Menting J, Nikolaus S, van der Veld WM, Goedendorp MM, Tack CJ, Knoop H. Severe fatigue in type 1 diabetes: Exploring its course, predictors and relationship with HbA1c in a prospective study. Diabetes Res Clin Pract. 2016;121:127-134. [Crossref]  [PubMed] 
  3. Singh R, Kluding PM. Fatigue and related factors in people with type 2 diabetes. Diabetes Educ. 2013;39:320-326. [Crossref]  [PubMed] 
  4. Fritschi C, Quinn L, Hacker ED, Penckofer SM, Wang E, Foreman M, Ferrans CE. Fatigue in women with type 2 diabetes. Diabetes Educ. 2012;38:662-672. [Crossref]  [PubMed]  [PMC] 
  5. Goedendorp MM, Tack CJ, Steggink E, Bloot L, Bazelmans E, Knoop H. Chronic fatigue in type 1 diabetes: highly prevalent but not explained by hyperglycemia or glucose variability. Diabetes Care. 2014;37:73-80. [Crossref]  [PubMed] 
  6. Seo YM, Hahm JR, Kim TK, Choi WH. Factors affecting fatigue in patients with type II diabetes mellitus in Korea. Asian Nurs Res (Korean Soc Nurs Sci). 2015;9(1):60-64. [Crossref]  [PubMed] 
  7. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24:1069-1078. [Crossref]  [PubMed] 
  8. Semenkovich K, Brown ME, Svrakic DM, Lustman PJ. Depression in type 2 diabetes mellitus: prevalence, impact, and treatment. Drugs. 2015;75:577-587. [Crossref]  [PubMed] 
  9. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lepine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martinez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacin C, Romera B, Taub N, Vollebergh WA; ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 2004;:38-46. [Crossref]  [PubMed] 
  10. Makine C, Karsidag C, Kadioglu P, Ilkova H, Karsidag K, Skovlund SE, Snoek FJ, Pouwer F. Symptoms of depression and diabetes-specific emotional distress are associated with a negative appraisal of insulin therapy in insulin-naive patients with Type 2 diabetes mellitus. A study from the European Depression in Diabetes [EDID] Research Consortium. Diabetic Med. 2009;26:28-33. [Crossref]  [PubMed] 
  11. Lasselin J, Laye S, Barreau JB, Rivet A, Dulucq MJ, Gin H, Capuron L. Fatigue and cognitive symptoms in patients with diabetes: relationship with disease phenotype and insulin treatment. Psychoneuroendocrinology. 2012;37:1468-1478. [Crossref]  [PubMed] 
  12. Unal-Cevik I, Sarioglu-Ay S, Evcik D. A comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the Turkish version of DN4. J Pain. 2010;11:1129-1135. [Crossref]  [PubMed] 
  13. Armutlu K, Keser I, Korkmaz N, Akbiyik DI, Sumbuloglu V, Guney Z, Karabudak R. Psychometric study of Turkish version of Fatigue Impact Scale in multiple sclerosis patients. J Neurol Sci. 2007;255:64-68. [Crossref]  [PubMed] 
  14. Gencay-Can A, Can SS. Validation of the Turkish version of the fatigue severity scale in patients with fibromyalgia. Rheumatol Int. 2012;32:27-31. [Crossref]  [PubMed] 
  15. Hisli N. Beck depresyon envanterinin universite ogrencileri icin gecerligi, guvenirligi. Psikoloji. 1989;7:3-13.
  16. Kocyigit H Aydemir O, Fisek G, Olmez N, Memis A. Kisa form-36 (KF-36)'nin Turkce versiyonunun guvenilirligi ve gecerliligi. Ilac ve Tedavi Dergisi. 1999;12:102-106.
  17. Agargun MY, Cilli AS, Kara H, Bilici M, Telcioglu M, Semiz UB, Basoglu C. Epworth uykululuk olceginin gecerligi ve guvenirligi. Turk Psikiyatri Dergisi. 1999;10:261-267.
  18. Agargun MY, Kara H, Anlar O. Pittsburgh uyku kalitesi indeksi'nin gecerligi ve guvenirligi. Turk Psikiyatri Dergisi. 1996;7:107-115.
  19. Jensen O, Bernklev T, Jelsness-Jorgensen LP. Fatigue in type 1 diabetes: a systematic review of Observational studies. Diabetes Res Clin Pract. 2017;123:63-74. [Crossref]  [PubMed] 
  20. Frier BM, Jensen MM, Chubb BD. Hypoglycaemia in adults with insulin-treated diabetes in the UK: self-reported frequency and effects. Diabet Med. 2016;33:1125-1132. [Crossref]  [PubMed]  [PMC] 
  21. Alleman CJ, Westerhout KY, Hensen M, Chambers C, Stoker M, Long S, van Nooten FE. Humanistic and economic burden of painful diabetic peripheral neuropathy in Europe: A review of the literature. Diabetes Res Clin Pract. 2015;109:215-225. [Crossref]  [PubMed] 
  22. Trikkalinou A, Papazafiropoulou AK, Melidonis A. Type 2 diabetes and quality of life. World J Diabetes. 2017;8:120-129. [Crossref]  [PubMed]  [PMC] 
  23. Baron R, Tolle TR, Gockel U, Brosz M, Freynhagen R. A cross-sectional cohort survey in 2100 patients with painful diabetic neuropathy and postherpetic neuralgia: differences in demographic data and sensory symptoms. Pain. 2009;146:34-40. [Crossref]  [PubMed] 
  24. Gore M, Brandenburg NA, Dukes E, Hoffman DL, Tai KS, Stacey B. Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manage. 200530:374-385. [Crossref]  [PubMed] 
  25. Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002;25:464-470. [Crossref]  [PubMed] 
  26. de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63:619-630. [Crossref]  [PubMed] 
  27. Katon W, von Korff M, Ciechanowski P, Russo J, Lin E, Simon G, Ludman E, Walker E, Bush T, Young B. Behavioral and clinical factors associated with depression among individuals with diabetes. Diabetes Care. 2004;27:914-920. [Crossref]  [PubMed] 
  28. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:837-853. [Crossref] 
  29. Polonsky WH, Fisher L, Guzman S, Villa-Caballero L, Edelman SV. Psychological insulin resistance in patients with type 2 diabetes: the scope of the problem. Diabetes Care. 2005;28:2543-2545. [Crossref]  [PubMed] 
  30. Iversen MM, Nefs G, Tell GS, Espehaug B, Midthjell K, Graue M, Pouwer F. Anxiety, depression and timing of insulin treatment among people with type 2 diabetes: Nine-year follow-up of the Nord-Trondelag Health Study, Norway. J Psychosom Res. 2015;79:309-315. [Crossref]  [PubMed]