Original Research Paper The effect of aromatherapy with bitter orange (Citrus aurantium) extract on anxiety and fatigue in type 2 diabetic patients Fariba Abdollahi a, *, Tofigh Mobadery b a School of Nursing and Midwifery, Qazvin University of Medical Science, Qazvin, Iran b School of Health Science, Iran University of Medical Science, Tehran, Iran A R T I C L E I N F O Article history: Received 23 June 2017 Available online 29 January 2019 Keywords: Aromatherapy Bitter orange extract Anxiety Fatigue Diabetic patients A B S T R A C T Objective: Studies have shown some complementary therapies to be effective in the management of diabetes and its comorbidities. The present study was conducted to evaluate the effect of an aromatherapy extract on anxiety and fatigue in type 2 diabetic patients. Methods: 60 type 2 diabetic patients were randomly assigned in two groups: patients in the intervention group received bitter orange (Citrus aurantium) extract inhalation aromatherapy for three consecutive nights before sleeping, whereas patients in the control group received usual care. Patients’ level of anxiety and fatigue was recorded before and after intervention using Visual Analog Scale (VAS). Results: The mean score of anxiety in patients in the intervention group before and after intervention were 63.13 Æ 40.42 and 52.9 Æ 3.57, respectively (P < 0.001). The mean score of anxiety in patients in control group before and after intervention were 56.73 Æ 39.52 and 56.6 Æ 3.93, respectively (P = 0.468). The mean score of fatigue in patients in intervention group before and after intervention were 65.7 Æ 39.63 and 63 Æ 3.93, respectively. The mean score of fatigue in patients in control group before and after intervention were 56.5 Æ 43.15 and 56.26 Æ 4.28, respectively (P = 0.436). Conclusion: The use of bitter orange extract inhalation aromatherapy is a potentially effective intervention to relive type 2 diabetics’ anxiety and fatigue. Further study in this regards are recommended. © 2019 Elsevier Ltd. All rights reserved. 1. Introduction Over the past thirty years, the international community has witnessed a 4-fold increase in diabetes [1]. In 2018, one in every 11 adults suffered from diabetes, of which 90% was type 2 diabetes [1]. It is estimated that in the year 2035, approximately 592 million people will have diabetes [2]. Diabetes is particularly common in Asian countries [1]. The prevalence of diabetes in Iran was evaluated between the years 2005 and 2011, and more than 4 million people in Iran were diagnosed with diabetes in 2011, a 35% increase compared to 2005 [3]. Diabetes is the ninth leading cause of death in the world, with cardiovascular disease is the leading cause of death in these patients [1]. Weight gain, obesity, nutrition and low-mobility lifestyle are some of the factors that increase the prevalence of type 2 diabetes [1,2]. Patients with type 2 diabetes face a number of co-morbid problems as a result of their diabetes, including fatigue and anxiety [4–6]. These problems can be extreme - the results of a study conducted in 2016 showed that more than 90% of women and men with type 2 diabetes expressed their anxiety in extreme range [7]. Some factors such as having a chronic disease, blood sugar fluctuations and the inability to control it, the need for hospitali- zation, complications of diabetes (including cardiovascular dis- ease, nephropathy and retinopathy) and long-term treatment can also lead to further anxiety in diabetics [8–12]. Fatigue may also be more prevalent in diabetics, with the results of another study, which examined fatigue in women with diabetes, showed that the fatigue in this group of women is significantly higher than healthy women [4]. Factors such as having a chronic disease, blood glucose levels and hemoglobin A1C, sleep disorders and decreased activity of daily life can cause fatigue in diabetic patients [13]. Anxiety and fatigue in diabetic patients can also have significant side effects. Disrupted daily functioning and decreased quality of life are often due to fatigue [14] and inconsistency with disease, decreased quality of life, and an increase in the risk of death can be associated * Corresponding author at: Qazvin university of Medical Science, 34917-36664, Qazvin, Iran. E-mail address: faribaabdollahi93@gmail.com (F. Abdollahi). https://doi.org/10.1016/j.aimed.2019.01.002 2212-9588/© 2019 Elsevier Ltd. All rights reserved. Advances in Integrative Medicine 7 (2020) 3–7 Contents lists available at ScienceDirect Advances in Integrative Medicine journal homepage: www.elsevier.com/locate/aimed