Last Updated Jun 2011
In January the American Diabetes Association released its 2011 National Diabetes Fact Sheet, indicating the disease now affects 25.8 million people in the United States—more than 8 percent of the total population of children and adults. What’s more, nearly 80 million Americans were found to have prediabetes, wherein in blood glucose levels are above the normal range but not high enough for a diabetes diagnosis. Of those, more than 50 percent will develop diabetes.
Diabetes commonly refers to a group of metabolic diseases characterized by high blood glucose levels, either because the body is unable to produce enough insulin (a hormone linked to carbohydrate and fat metabolism which regulates the amount of glucose in the blood) or because the body does not respond properly to the insulin that is produced. Of the three major types of diabetes—Type I, Type II and Gestational Diabetes—Type II is the most common and normally occurs during adulthood.
Peripheral Neuropathy in the Diabetic Patient
While symptoms may develop slowly depending upon the type of the disease, one of the most common conditions associated with Type I and Type II diabetic patients is peripheral neuropathy. Peripheral neuropathy refers to damage to the fragile peripheral nerves, including those in the hands, arms, legs and feet. Roughly 60 percent of all diabetics will develop some degree of nerve damage, which over time can lead to debilitating musculoskeletal changes in the body.
Symptoms associated with peripheral neuropathy may include decreased circulation to the extremities, as well as numbness, pain, tingling, a burning sensation and muscle weakness—all of which can severely decrease a patient’s quality of life and may result in secondary complications such as falls, fractures, foot ulcers and amputations.
The Role of PT in Diabetes Treatment
In addition to diet and lifestyle changes as well as drug treatment in certain cases, physical therapy plays a critical role in treating the diabetic patient. Working closely with the patient’s care team, the physical therapist can determine a treatment plan to address the musculoskeletal complications associated with diabetes and ultimately help restore joint and muscle function, reduce pain, and improve range of motion.
In diabetic patients, problems associated with the feet are most common—including Charcot Neuropathy (or simply Charcot Disease), which causes a gradual breakdown of the bones and joints of the foot. Foot disease is actually the leading cause of hospitalization among Americans with diabetes, and approximately 15 percent of diabetics develop lower extremity ulcers. Diabetes also accounts for approximately 50 percent of all non-traumatic amputations in the United States.
Complications affecting the hands are also commonly seen in diabetic patients, including carpal tunnel syndrome; diabetic cheiroarthropathy (also known as diabetic stiff hand syndrome or limited joint mobility syndrome); Dupuytren’s contractures (crippling hand deformities); and flexor tenosynovitis, which causes severe pain in the finger joints.
Better Diabetes Care through Education
Though debilitating, many of the structural changes caused by diabetes can be prevented or alleviated with proper care. Early identification of the potential for injury or ulcer development is critical, as is early intervention to reduce the risk of amputation. Ongoing education about foot care and proper foot wear also plays an important role in preserving the overall health and quality of life of your diabetic patients. By understanding how diabetes affects the body and the benefits of effective care planning, therapy professionals can play a powerful role in providing superior diabetes care.
For more information on the effects of diabetes on the body, including common musculoskeletal complications, symptoms and treatment methods, view our comprehensive course Musculoskeletal Complications of Diabetes.
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