Fatigue, Diabetes Distress and Emotional Well-Being in T1D
Jiska Embaye, Wessel van Wieringen, Hans Knoop, Frank J. Snoek, Maartje de Wit
The interconnectedness between symptoms of fatigue, diabetes distress and emotional well-being in people with type 1 diabetes: A network analysis approach. J Health Psychol. 2026;1–12. Epub 2026 Jan 21.
People living with type 1 diabetes (T1D) frequently experience fatigue, diabetes distress, and reduced emotional well-being. These problems often co-occur, yet little is known about how they relate at the level of individual symptoms. Do they reinforce each other, or do they represent largely separate experiences? This study, co-authored by Diabeter Center Amsterdam/Amsterdam UMC researcher Maartje de Wit, used network analysis to map the connections between individual symptoms of all three constructs in a sample of adults with T1D.
Baseline data were drawn from 319 adults with T1D (mean age 43, 65% female) who registered for a web-based self-guided mental health intervention in the Netherlands. Fatigue was measured with the CIS-fatigue subscale, diabetes distress with the PAID-11, and emotional well-being with the WHO-5. Network analysis examined which symptom-level connections were consistent and strong, both within and between the three constructs.
Key POINTS:
- Psychological burden was high across the board: More than half of participants reported severe fatigue (54%), over two thirds reported elevated diabetes distress (71%), and nearly six in ten had low emotional well-being (59%).
- Each construct showed strong internal cohesion: Within fatigue, diabetes distress, and emotional well-being separately, symptoms were tightly interconnected — suggesting these are internally consistent experiences at the symptom level.
- Few connections crossed between constructs: Despite the high rates of co-occurrence, only a handful of bridging symptoms linked the three constructs to each other. The constructs appeared to function largely independently in the network.
- The main bridge between emotional well-being and diabetes distress was a negative connection between feeling cheerful (WHO-5) and feeling depressed when thinking about diabetes (PAID-11) — suggesting that improving mood may positively affect diabetes-specific distress, and vice versa.
- No consistent connections were found between fatigue and diabetes distress, supporting the hypothesis that fatigue in T1D may be driven by transdiagnostic mechanisms — shared across chronic diseases in general — rather than being diabetes-specific.
- Diabetes distress formed a separate cluster, consistent with earlier network studies in type 2 diabetes, reinforcing its status as a distinct psychological construct that reflects the specific demands of living with diabetes rather than general emotional distress.
The findings suggest that when people with T1D experience multiple psychological problems simultaneously, these may not necessarily feed into each other at the symptom level. This has implications for treatment: symptom-specific interventions — targeting fatigue, distress, or emotional well-being separately — may each be warranted, rather than assuming that treating one will automatically alleviate the others. Longitudinal and individual-level studies are needed to better understand how these dynamics evolve over time.
Concluding, the authors state
"Future research should explore individual networks using longitudinal methods to better understand these dynamics and to stimulate personalized care strategies." -
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