# Prediction of Diabetic Nephropathy from the Relationship between Fatigue, Sleep and Quality of Life
###### Abstract  
Fatigue and poor sleep quality are the most common clinical complaints of people with diabetes mellitus (DM). These complaints are early signs of DM and are closely related to diabetic control and the presence of complications, which lead to a decline in the quality of life. Therefore, an accurate measurement of the relationship between fatigue, sleep status, and the complication of DM nephropathy could lead to a specific definition of fatigue and an appropriate medical treatment. This study recruited 307 people with Type 2 diabetes from two medical centers in Northern Taiwan through a questionnaire survey and a retrospective investigation of medical records. In an attempt to identify the related factors and accurately predict diabetic nephropathy, we applied hybrid research methods, integrated biostatistics, and feature selection methods in data mining and machine learning to compare and verify the results. Consequently, the results demonstrated that patients with diabetic nephropathy have a higher fatigue level and Charlson comorbidity index (CCI) score than without neuropathy, the presence of neuropathy leads to poor sleep quality, lower quality of life, and poor metabolism. Furthermore, by considering feature selection in selecting representative features or variables, we achieved consistence results with a support vector machine (SVM) classifier and merely ten representative factors and a prediction accuracy as high as 74% in predicting the presence of diabetic nephropathy. fatigue; sleep quality; quality of life; diabetic nephropathy; feature selection; data mining +
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subjective and unquantiifiable, it is difficult to define it specifically and treat it medically, but it truly affects patients' quality of life (QoL) and behavioral ability. According to the literature, diabetes-related fatigue can be caused by three major categories of factors: first, physiological factors, including acute or chronic hyperglycemia and hypoglycemia, glycemic variability, and diabetes symptoms; second, psychological factors, including emotional stress and sleep problems; third, lifestyle factors, including increase in weight or body mass index and decrease in physical activity [1]. Thus, fatigue is not entirely psychological and is usually accompanied by actual physical weakening. The signs that indicate that fatigue may be derived from physical weakening include muscle weakness, a lack of spirit, weight loss, sluggishness, and reduced vitality [2; 3]. However, in the early stage of the comorbidity, patients with diabetes are also likely to suffer from a decline in sleep quality; hence, an accurate quantitative assessment of lifestyle, exhaustion, and sleep status of diabetic patients is not only precautionary but necessary. Moreover, poor control of DM induces multiple complications, such as vascular disease, neuropathy, eye lesions, and renal disease, and long-term medical attention has become an encumbrance worldwide. Among all the complications, diabetic nephropathy is associated with the highest costs for individuals, families, and society. Due to the fact that nephropathy aggravates extreme fatigue and insomnia especially when patients need dialysis [4; 5; 6], recent studies have noted that insomnia, fatigue, and physical weakness symptoms in diabetic patients are found not only in elderly patients, but also in adolescents [7] and adults [8; 9], and a debilitating condition in individuals who are not yet middle-aged is indicative of early aging [10]. Because fatigue is closely related to sleep status and glycemic control, it has been reported that a reduction in the workplace performance of fatigued diabetic patients is indirectly linked to depression [11]. It is important to note that a lack of sleep often results in a lower spirit or even depression, especially for people with diabetes. [1; 12].