# Prediction of Diabetic Nephropathy from the Relationship between Fatigue, Sleep and Quality of Life
## 3 Methodology
### Instruments  
Questionnaires and scales were chosen for hypothesis testing in this study based on the literature review. Patients with type 2 diabetes (T2 DM) should receive lifestyle modifications under a regular medication treatment and a metabolic follow-up to prevent the occurrence of multiple complications that induce poor quality of life [4; 5; 6]. Therefore, we collected basic lifestyle information, physical status, sleep quality measurements (PSQI), multidimensional fatigue inventory (MFI) results, and quality of life SF-12 questionnaire results. Furthermore, the metabolic control index was included and determined from blood tests and urine analyses, so 128 features were assessed in this study. The data collection process and the features were assessed from the associated factors are shown in Figure 1.  
Figure 1: The data collection process and the features obtained from the questionnaires.  
**Questionnaire one:** Basic information and lifestyles  
The questionnaire consisted of 25 questions, which surveyed the respondents' living habits in the past six months, including (1) lifestyle habits (smoking, drinking, betel nut chewing, and exercise habits); (2) eating habits (red meat, fish, fruit, and vegetable consumption, and dining out frequency); (3) family history and personal medical history; and (4) body type measurements (height, weight, body mass index, waist circumference, and hip circumference).  
**Questionnaire two:** Sleep quality measurement  
The Pittsburgh sleep quality index (PSQI) is a self-report questionnaire that measures sleep quality and disorders and is widely used clinically, and it has superior reliability and validity for patients with a history of depression and sleep disorders. The scale includes seven components concerning the previous month, including subjective sleep quality, sleep time, sleep duration, sleep efficiency, sleep disorders, medication, and daytime dysfunction, and the scores of each component can be summed differently with the use of different rules. The reliability as measured by [PERSON]'s alpha was 0.72.  
**Questionnaire three:** Multidimensional fatigue inventory (MFI)  
A total of 20 questions were used to explore the subjective fatigue of the patients and the impact on their lives. The reliability as measured by [PERSON]'s alpha was 0.88.  
**Questionnaire four:** Quality of life (QoL) SF-12  
The SF-12 questionnaire designed by [PERSON] et al. was used, and the reliability as measured by [PERSON]'s alpha was 0.81 for quality of life in this study.  
The second part included a retrospective study on the metabolic control index and the diagnosis of diabetic nephropathy. The indicators include systolic and diastolic blood pressure, AC sugar (fasting plasma glucose level) and PC sugar (postprandial 2 hours' plasma glucose level), HbA1C (glycoslated hemoglobin), urine micro albumin, and the Charlson comorbidity index (CCI), and the results were obtained retrospectively from the medical records on the day of the patient's visit. The main purpose of this part was to determine whether renal disease is related to fatigue, sleep status, and quality of life in diabetic patients and the relationship between these factors.