Diabetes is rapidly becoming an epidemic in the United
States, epically Type II (formally called adult onset). Type
II usually appears in persons over the age of 40 and is
associated with physical inactivity and in persons who are
overweight. Usually symptoms are not obvious at first. The
symptoms associated with diabetes can include: frequent
urination, excessive thirst, extreme hunger, unusual weight
loss, increased fatigue, irritability and blurry vision (1).
Recent studies indicate that the early detection of diabetes
symptoms and treatment can decrease the chance of developing
the complications of diabetes (1). However, if left
untreated, diabetes can lead to blindness, kidney failure,
amputation or death.
The American Diabetes Association reports that there are
23.6 million people in the United States, or 8% of the
population, who have diabetes. They report that the total
annual economic cost of diabetes in 2007 was estimated to be
$174 billion. Medical expenditures totaled $116 billion and
were comprised of $27 billion for diabetes care, $58 billion
for chronic diabetes-related complications, and $31 billion
for excess general medical costs. Indirect costs resulting
from increased absenteeism, reduced productivity,
disease-related unemployment disability, and loss of
productive capacity due to early mortality totaled $58
billion (1).
A common condition associated with patients who have
diabetes is peripheral neuropathy. Peripheral neuropathy is
the term used for damage to the nerves of the peripheral
nervous system, which may be caused either by diseases of
the nerve or from the side-effects of systemic illness.
Peripheral neuropathy is not a disease itself and is
commonly diagnosed in people when no pre-existing cause is
present. Less than three percent of the general population
is affected by peripheral neuropathy, yet sixty percent of
diabetics will develop some degree of nerve damage. However,
some known causes of peripheral neuropathy include diabetes
mellitus, alcoholism, radiation, and chemotherapy.
The diagnosis of peripheral neuropathy is performed based on
the symptoms that the patient is experiencing at the time of
the doctor’s examination. Some common symptoms that a
patient may experience are sensations of decreased
circulation in the extremities, such as numbness, tingling,
alternating burning hot and ice cold feelings, sharp or dull
pain, decreased coordination, and muscle fatigue.
Furthermore, some patients have reported the feeling of
wearing a stocking or glove when the patient is afflicted
with peripheral neuropathy (2). Patients with peripheral
neuropathy not only notice pain but may experience balance
problems or difficulty walking as well. These are issues
that should also be addressed in physical therapy.
Another tool which is available to some physical therapists
for treating complications associated with diabetes is
Anodyne Therapy.
Anodyne Therapy received FDA approval in 1994 and utilizes
monochromatic infrared energy (MIRE) to release nitric oxide
from the patient’s red blood cells. The company says this
improves nerve function and is important for making new
blood vessels and healing wounds. As the company notes, “low
levels of nitric oxide are common in people with diabetes
and are a major factor in the poor circulation, loss of
sensation, chronic falls, foot ulcers and pain of diabetic
peripheral neuropathy.” Therefore, this type of therapy is a
simple, safe, non-invasive treatment option for people who
suffer from pain and numbness at the feet.
Numerous studies conducted have supported these findings
with the use of Anodyne Therapy. In one study that was
published in Diabetes and Its Complications, 2239 patients
who were treated with Anodyne Therapy and then examined.
From the examination they found that 67% of patients with
chronic foot and leg pain had a decrease in symptoms after
Anodyne. Physical and Occupational Therapy in Geriatrics
also reported that 272 patients at 7 facilities demonstrated
significant pain reduction and improvement in functional
outcomes with Anodyne Therapy.
The patients’ history, sensation, balance, strength and
flexibility are assessed before treatment is started.
Anodyne Therapy treatment consists of strapping small pads to the
affected areas for approximately 30 minutes. Patient may
feel some warmth during the session, but no significant
pain. Along with utilizing Anodyne Therapy, the physical therapist
will also design an individualize
exercise program for each patient to address his or her
specific needs. Balance, gait, stretching exercises and
patient education (ie. proper foot care) are
usually incorporated to help patients improve their
functional levels.
Anodyne and physical therapy treatments are covered by all
major insurances including Medicare, Medicaid and Title XIX.
Aerobic and resistance exercise
are also a key component of the overall treatment plan. Recent
studies have shown that these forms of activities help control
the blood sugar levels of patients with diabetes. One
study, included 251 adults, between ages 39 and 70, who were
not exercising regularly and had type 2 diabetes were
divided into four groups, one performing 45 minutes aerobic
training three times per week, another 45 minutes of
resistance training three times per week, the third 45
minutes each of both three times per week, and the last no
exercise. The study found that the group which performed both kinds of exercise had
about twice as much improvement as either other group alone
(3).
Another study involving 10,455 subjects found that diabetics
who attended exercise classes had more significant
improvements than people who focused on trying to change
exercise, diet modification and medication at the same time
(4).
People with diabetes can make great gains with exercise. Many of our patients need help getting started with an
exercise program, because they have never been very active. As
physical therapists it is essential that we not only address
our patients' deficits but educate our patients regarding
lifestyle changes and self management as this can drastically improve their quality
of life as well.
Last revised: September 8, 2009
by Pete Balik, MPT, CSCS
