Last Updated Nov 2010
There is no doubt that diabetes is a time bomb. By 2050, some experts believe 1 in 3 Americans will have the disease. The question is: what role can a physical therapist play in defusing this bomb? According to the most recent numbers, approximately 24 million Americans have diabetes. Over 90 percent of these have type 2 diabetes and of those with type 2, 90% are (perk up your ears) overweight or obese.
This is why the American Diabetes Association and the Centers for Disease Control say (and I paraphrase) “take care of the weight and you take care of the problem.” As a PT you might be thinking. “Okay. That’s nice. But aside from talking numbers and generalities with patients, what else am I supposed to do? Diabetes is an endocrine disorder. What’s that got to do with me?”
Well, maybe you’re not wondering that. But let’s just say, that hypothetically, you think PTs don’t have a role, let alone, a gargantuan one in reversing an epidemic that costs the U.S. over 170 billion dollars and over 200,000 lives a year.
Yet as the statistics clearly show, addressing obesity may dramatically reduce the number of people with diabetes. And what tools do we have to combat obesity? How about exercise? Don’t PTs know something about that?
This battle can’t be fought reactively—if it were, we would cut our losses and end up with the pyrrhic victory of insulin shots and metformin cocktails.
No, the battle against diabetes, if successfully waged, would require pre-emptive attack. In a word, we need PREVENTION. At worse, we need early intervention. What’s all that anatomy, physiology, neurology, exercise, and movement science worth if we don’t apply it to one of the greatest epidemics of our time?
How to do it, you ask? It’s pretty easy considering the chances that someone you meet will have pre-diabetes (57 million people) or diabetes (over 24 million people). Opportunity? Check.
Now, how about some education? It’s not hard to explain to a patient how belly fat is connected to diabetes and how muscle is more efficient with sugar uptake. It’s not difficult to do a sensory screen, a monofilament test, or a quick assessment of the patient’s diabetes control. It’s not hard to make some home exercise suggestions that will not only decrease weight to reduce osteoarthritis, but also decrease the risk or complications of diabetes.
We spend so much time with our patients, more so than almost any other healthcare provider. We can’t limit our focus to L3 or the medial epicondyle. Connections need to be made, first in our minds, then in the minds of patients. The key is connection, then communication.
For example, think about how diabetes impedes the healing process after a TKA. The knee doesn’t just float in space. It’s connected to a person and the sum of that person’s systems and physiology, whether normal or abnormal.
So if your 55 year old patient has diabetes and feels frustrated about the slow recovery of his knee, why not take the opportunity to touch on the diabetes disease process?
As PTs we receive such broad training. Cardiovascular, respiratory, integumentary, musculoskeletal, neurological, endocrine…we cover it all. It’s time we bring our knowledge to bear on this silly disease that struts around arrogantly as if it owns the place.
If you’re convinced but don’t have time or don’t know of solid resources to help your patients control diabetes without medications, consider telling them about or giving them a copy of Kathy Smith: Project You! Type 2. It’s the only exercise and nutrition program developed together with the American Diabetes Association. More importantly, it’s not pills and shots which 9 out of 10 people with diabetes would rather do without.
Read more about author Son Trinh