Problem

Commonly, the term fatigue refers to a everyday experience that most individuals perceive after inadequate sleep or rest, or after overload of physical strength. Apart from this, the term fatigue also describes a symptom considered to indicate the presence of diseases (cancer, Parkinson’s disease, poststroke, Myasthenia Gravis, etc). Although fatigue also occurs in other medical disorders, the importance of fatigue may be greater in individuals with type 2 diabetes as the complex management strategies that must be continually maintained. In Copenhagen, findings from an epidemiological study of 1,137 general practice patients with newly diagnosed type 2 diabetes revealed that fatigue was present in approximately 61% of patients at the time of diagnosis. Another study in China also indicated that the incidence of fatigue in diabetic population reached to 91.92%. However, how to diagnostic and treat fatigue is still remains a big problem for health care providers, as there has no agreement on standardized definition and diagnostic criteria of fatigue. In addition, it is very challenging to transform the subjective feeling of fatigue into a objective indicator, because there is a great discrepancy among causes and indicators. In general, fatigue is recognized as a complex phenomenon including physiological, psychological, and situational component. To date, there are a dozen of known scales of fatigue which contains unidimensional and multidimensional scales, such as Brief Fatigue Inventory (BFI), Fatigue Severity Scale (FSS), Visual Analog Fatigue Scale (VAFS), Fatigue Scale-14 (FS-14), Multidimensional Fatigue Index-20 (MFI-20), Multidimensional Assessment of Fatigue (MAF) and so on. However, there are few scales that appear to identify and measure fatigue in individuals with diabetes adequately. For example, it was reported in the literature that Fatigue Severity Scale (FSS) and Visual Analog Fatigue (VAFS) have good reliability and validity in measuring diabetic related fatigue. But fatigue in people with diabetes is likely to be multidimensional, these two unidimensional scales cannot reflect the types and features of the diabetic related fatigue comprehensively. As above, the most accurate or appropriate fatigue scales of diabetic related fatigue are also remaining controversial. The Multidimensional Fatigue Inventory (MFI) is a 20-item self-report instrument designed to measure fatigue which has been used in different countries. It covers five dimensions: general fatigue, physical fatigue, mental fatigue, reduced motivation and reduced activity. This instrument was tested for its psychometric properties in cancer patients receiving radiotherapy, patients with the chronic fatigue syndrome, psychology students, medical students, army recruits and junior physicians. However, there are no studies reported whether it is suitable for patients with type 2 diabetes or not. Some people reported that fatigue has negative effect on their health and quality of life. For diabetes patients, fatigue is likely a potential factor leading to poor health education effect and a barrier to their health-promoting behaviors, such as participating in diabetes self-care regimens, following a healthy eating plan or participating in regular exercise. So it is necessary to explore the related factors and intervention measures of fatigue in individuals with diabetes.

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