Professional Documents
Culture Documents
Physiotherapy
in the
treatment
of type 2
diabetes
Physical training reduces the level of glucose in the blood and may reduce the need for
antidiabetic drugs in patients with type 2 diabetes. As, besides diabe-tic symptoms,
training instructors should manage muscular skeletal problems, neuropathy, heart and
lung diseases and overweight, the training should be provided by physiotherapists at
public and private clinics.
care system. These treatment programs have been implemented at the municipal level and
patients are now referred to physical training programmes all over the country.
The importance of physiotherapy-led training interventions is emphasised by the prevalence of arthritis, other joint pains, joint replacements, stroke and respiratory problems
(12-14)
among patients with Type 2 diabetes. Special attention should be paid to these nondiabetic conditions when conducting individually tailored training programs in terms of adjusting intensity and load as well as choosing exercises. Physiotherapists have a wealth of
experience of training patients suffering from various symptoms and diagnoses. Once these
are identified and the training programs adapted, the patients can engage safely in training
sessions.
Socio-economic impact
The effect of long-term physical training on blood glucose is at the same level as anti-diabetic drug or insulin therapy in patients with type 2 diabetes (6). Thus, if physical activity
interventions are accepted by the patients, training may reduce the use of medication and
thereby become a cost-saving initiative (6).
A 1% reduction in blood glucose control (HbA1c) is associated with a risk reduction of 21%
of any complication related to diabetes (1). Physical training is recognised as a method of treatment to reduce the blood glucose. Furthermore, training also reduces other morbidity and
mortality risk factors suggesting that such interventions save costs on a long term basis.
This was shown to be true in a recent meta-analysis; training programs are cost-effective in
terms of longer life expectancy with improved quality of life (Quality Adjusted Life Year) (15).
Training interventions in patients with type 2 diabetes are offered as exercise on prescription in Denmark. Patients with type 2 diabetes may engage in training with patients
who suffer from other chronic diseases, such as heart disease. When more patients with different chronic diseases can be included in training programs, it may be easier to implement
the training in local communities. Previous results have shown that training interventions
across diagnosis can be conducted with relevant reductions in the blood glucose leading to
better prognoses (16,17).
Physiotherapists work in multi-disciplinary teams that deliver patient education in the
type 2 diabetes treatment programs. Patient education is an evidence-based intervention
in type 2 diabetes (18). Physiotherapists are using empowerment-based patient education to
help patients to make life style changes including engaging in enhanced physical activity (19).
Finally, training given to patients with type 2 diabetes may also be effective in combating other pre-existing health problems, including loss of bone strength, musculoskeletal
pain and reduced mental health.
Conclusions
Physical training is a cornerstone in the treatment of type 2 diabetes. Training programs are
cost-effective; they prevent medical complications and reduce the mortality risk.
Physiotherapists play an important role in the treatment of type 2 diabetes by leading
evidence-based training programs. The importance of having physiotherapist-led training
programs is emphasised by the patients individual impairments and other disorders.
Number of patients
Disease severity
2 diabetes in Denmark
(20)
- Is cost-effective
The Association of Danish Physiotherapists has asked a group of experts to present a short summary of
the latest evidence in a specific topic/area of physiotherapy. The summaries are ment to be used as tools
to highlight and promote physiotherapy. This summary about type 2 diabetes is written in 2013 by physiotherapist, ph.d. Stig Mlsted.
References
(1) Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with
macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational
study. BMJ 2000 Aug 12;321(7258):405-412.
(4) Umpierre D, Ribeiro PA, Kramer CK, Leitao CB, Zucatti AT, Azevedo MJ, et al. Physical activity advice only or
structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and
meta-analysis. JAMA 2011 May 4;305(17):1790-1799.
(5) Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis.
Diabetes Care 2011 May;34(5):1228-1237.
(6) Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors
for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 2006 Nov;29(11):2518-2527.
(9) Belli T, Ribeiro LF, Ackermann MA, Baldissera V, Gobatto CA, Galdino da Silva R. Effects of 12-week over-
ground walking training at ventilatory threshold velocity in type 2 diabetic women. Diabetes Res Clin Pract
2011 Sep;93(3):337-343.
(10) Negri C, Bacchi E, Morgante S, Soave D, Marques A, Menghini E, et al. Supervised walking groups to increase physical activity in type 2 diabetic patients. Diabetes Care 2010 Nov;33(11):2333-2335.
(11) Kodama S, Tanaka S, Heianza Y, Fujihara K, Horikawa C, Shimano H, et al. Association Between Physical
Activity and Risk of All-Cause Mortality and Cardiovascular Disease in Patients With Diabetes: A metaanalysis. Diabetes Care 2013 Feb;36(2):471-479.
(15) Coyle D, Coyle K, Kenny GP, Boule NG, Wells GA, Fortier M, et al. Cost-effectiveness of exercise programs in
type 2 diabetes. Int J Technol Assess Health Care 2012 Jul;28(3):228-234.
Download the complete list of references on fysio.dk/fagligstatus