An integrative review of fatigue in adults with type 2 diabetes mellitus: Implications for self-management and quality of life.

Abstract

To synthesise empirical studies on factors related to fatigue and its impact on diabetes self-management (DSM) and quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM). Fatigue is commonly reported in people with T2DM, a chronic condition that is highly prevalent worldwide. However, a holistic understanding of the consequences and factors related to fatigue in adults with T2DM is not well synthesised. This integrative review used Whittemore and Knafl's methodology and was reported according to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. The theory of unpleasant symptoms (TOUS) was used as a conceptual model to guide the review. The PubMed, PsychINFO and CINAHL databases were searched to identify studies that recruited adults with T2DM, were peer-reviewed, written in English and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data. Twenty-nine articles met the inclusion criteria: 23 observational studies, two randomised controlled trials, one quasi-experimental study and three qualitative studies. All articles were of high quality. Physiological (e.g. T2DM duration, complications and inflammatory biomarkers), psychological (e.g. diabetes distress, depression and sleep quality) and situational factors (e.g. race/ethnicity, education and social support) were related to fatigue. Studies reported fatigue as a barrier to physical activity, healthy eating behaviours and the physical aspect of QOL. Multiple factors are related to fatigue in adults with T2DM. Gaps in the literature include the multiple dimensions of fatigue, the effectiveness of interventions to alleviate fatigue and fatigue experiences in under-represented populations. This integrative review supports the complex origin of fatigue and its impact on adults with T2DM. Nurses should evaluate modifiable factors related to fatigue and provide support to help improve DSM and QOL in this population.