How Do Physiotherapists Help Treat Diabetes?

  •   July 5, 2016
  •  Leanne Loranger, PT

Diabetes is a disease that happens when the body is unable to sufficiently produce or properly use insulin. Insulin is a hormone that allows the body’s cells to absorb sugar from the blood stream and use that sugar for energy.1 An estimated 2.7 million Canadians have diabetes,2 and as many as one in five of these people don’t know that they are diabetic.1

Diabetes leads to high blood glucose levels (hyperglycemia), which over time, causes complications such as heart disease, kidney disease, lower leg amputations and eye problems.1 People with diabetes are three times more likely to be admitted to hospital with heart disease (including high blood pressure), 12 times more likely to be hospitalized with kidney disease, and 20 times more likely to require a leg amputation than people who are not diabetic.1

People with diabetes are also more likely to experience other chronic conditions such as arthritis, chronic obstructive pulmonary disease (COPD) and depression, partly because these conditions have similar risk factors and underlying causes.1

Most importantly, although diabetes does not typically directly cause death, complications associated with diabetes do. As many as 29.9% of people who died in 2007 had diabetes, though only 3.1% of deaths were directly attributable to diabetes.1 In fact, people with diabetes have double the mortality rate of people without diabetes and experience decreased life expectancy.1

There are several types of diabetes:1

  • Type 1 diabetes:
    • Previously known as juvenile diabetes.
    • Usually occurs in those under 40.
    • An autoimmune disease in which the person’s immune system attacks insulin producing cells.
    • Requires an external source of insulin.
  • Gestational diabetes:
    • Diagnosed when hyperglycemia occurs during pregnancy.
    • Usually resolves following the baby’s delivery.
    • Risk factor for type 2 diabetes later in life.
  • Type 2 diabetes:
    • Sometimes referred to as non-insulin-dependent diabetes.
    • Usually seen in those over age 40, but can occur in children and youth.
    • Occurs when the body can’t produce enough insulin or when the body cannot effectively use the insulin it makes.
    • Most common among people who are overweight or obese, inactive, or members of certain ethnic groups.
    • People who are overweight or obese are two to four times more likely to have diabetes.1
    • Smoking is also associated with an increased risk of type 2 diabetes.1
    • The vast majority (90-95%) of people with diabetes have type 2 diabetes.1

Risk Factors

When blood glucose levels are not well controlled, people with diabetes are at an increased risk of infection, demonstrate delayed wound healing, and experience damage to the blood vessels of the body (leading to eye problems, nerve damage and heart and kidney disease).1 Many people with diabetes also benefit from lowering blood pressure and cholesterol, as there is an increased risk of illness and death due to heart disease.3 Given the alarming statistics related to type 2 diabetes (both how common it is and the many associated complications), it is critical to take steps to manage blood glucose levels. Achieving glycemic control (keeping blood glucose levels in a desired range) and managing heart disease risk factors will limit diabetes’ impact on the health and wellbeing of those with this disease.

Treating diabetes

Treatment of type 2 diabetes often includes medications to reduce blood glucose levels. Aggressive medical management of blood glucose has long been the norm for people living with diabetes, and many people with type 2 diabetes are treated with pills, injections or a combination of both to control their blood glucose.3 However, there has been some indication that this approach can, over time, lead to a variety of complications and negative outcomes.3

Non-pharmaceutical treatment of diabetes focuses on dietary changes and exercise for weight loss and to improve glycemic control.4 For diabetics who are overweight or obese, the benefits of weight loss also extends to a reduction in cardiovascular risk factors (e.g., blood pressure, cholesterol).5

Researchers suggest that physical activity paired with weight loss increases insulin sensitivity,6 with clinical guidelines suggesting that lifestyle changes including diet and physical activity advice can be the first line of treatment for some individuals diagnosed with type 2 diabetes.3

Among those who require medication at the time of diagnosis, successful lifestyle changes can lead to a change or discontinuation of medications when glycemic control is achieved.3 In one study a two to five percent weight reduction achieved through lifestyle change was shown to lead to clinically significant improvement in glycemic control.6 A combined analysis of several studies also demonstrated that successful lifestyle change interventions had a similar impact on glycemic control as pharmaceutical treatment when compared over a two year period.7

How physiotherapy can help

Research has demonstrated that effective treatments to improve blood glucose and cardiac risk factors include intensive lifestyle interventions and behavior modification,4,5,7 and that structured exercise interventions are more effective than general advice to be more active.8 That’s how physiotherapy can help people with, or at risk of developing diabetes!

Despite the strong evidence to support exercise as a treatment for people with diabetes, it can be hard to change behavior. Many people, both with and without diabetes, struggle to incorporate exercise into their daily lives; however, several of the conditions associated with diabetes can make participation in exercise more difficult. Physiotherapists are movement experts. Physiotherapists can help by providing tailored exercise recommendations that consider a person’s baseline activity level and other health concerns. Physiotherapists are also skilled in coaching people to make the type of behavior changes that are needed to improve patient outcomes in diabetes.

In addition to helping with lifestyle change to treat diabetes itself, physiotherapists can also help people with diabetes manage the complications and conditions associated with diabetes. For example, some physiotherapists work in the area of wound care, treating people with diabetic foot wounds and providing advice regarding skin care and footwear to help prevent wounds. Many physiotherapists focus on balance, which can be impaired in diabetics who have sensation loss in their feet due to peripheral neuropathy (nerve damage). Others work in the area of pain management and treat people with pain caused by diabetic neuropathy.

To find a physiotherapist to help you manage your diabetes click here. Search for the condition/injury that best describes your symptoms. For instance, if you have nerve damage (neuropathy) search for chronic pain. Or, if you have other health concerns and are looking for help with a structured exercise program, search health and wellness promotion.


  1. Public Health Agency of Canada. Diabetes in Canada: Facts and figures from a public health perspective. Ottawa, 2011
  2. Canadian Diabetes Association & Diabetes Quebec. Diabetes: Canada at the tipping point. Charting a new path. 2011. Available from: http://www.diabetes.ca/publications-newsletters/advocacy-reports/diabetes-canada-at-the-tipping-point.  Accessed on June 22, 2016.
  3. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR. Management of hyperglycemia in type 2 diabetes: A patient-centered approach. Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012; 35:1364-1379.  
  4. Knowler WC, Barrett-Connor PHE, Fowler SE, Hamman RF, Lachin JM, Walker EA & Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine 2002; 346(6): 393-403.
  5. Wing RR, Lang W, Wadden TA, Safford M, Knowler WC, Bertoni AG, Hill JO, Brancati FL, Peters A, Wagenknecht L. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care 2011; 34:1481-1486.
  6. Qin L, Knol MJ, Corpeleijn E, Stolk RP. Does physical activity modify the risk of obesity for type 2 diabetes: A review of epidemiological data. European Journal of Epidemiology 2010; 25:5-12.
  7. Avery L, Flynn D, van Wersch A, Sniehotta FF, Trenell MI. Changing physical activity behavior in type 2 diabetes. Diabetes Care 2012; 35:2681-2689.
  8. Umpierre D, Ribeiro PA, Kramer CK, Leitao CB, Zucatti ATN, Azevedo MJ, Gross JL, Ribeiro JP, Schaan BD. Physical activity advice only or structure exercise training and association with HbA1c levels in type 2 diabetes: A systematic review and meta-analysis. Journal of the American Medical Association 2011; 305(17):1790-1799. Available from: http://jama.jamanetwork.com/article.aspx?articleid=899553.   Accessed on June 22, 2016.