By 2020 India is going to be a diabetic capital as its epidemic is growing in size and complexity. There is an increasing realization that physicians alone are unable to provide the care required by people with diabetes to help them live life to the fullest. Physiotherapy is having a lot to offer in prevention, management & complications of diabetes mellitus. Physiotherapy involves physical treatment techniques such as massage, use of electrotherapeutic and mechanical agents rather than drugs for the management of a condition. Any person with diabetes whose aching legs have experienced relief after a massage or whose feet have been relaxed after a soak in cool water will testify to the importance of physiotherapy in relieving their symptoms. However diabetologist generally have been slow to exploit the benefits of this science. This may be due to lack of awareness of its potential for improving health and wellbeing, or because of shortage of trained personnel in our country. Role of physiotherapy in prevention of diabetes: The diabetes prevention project demonstrated that life style modification, including intensive exercise is more effective in preventing diabetes than pharmacological therapy and highlighted the role of trained professionals in motivating people to follow lifestyle interventions.  

How Physiotherapy Helps In Management of Diabetes: Physiotherapists are able to help diabetic people by improving their quality of life and contributing to overall control of blood glucose. Individualized exercise programs are able to maintain good blood glucose control and achieve optimal weight. Physiotherapy leads to metabolic improvements even in the absence of weight lose, reducing the frequency of cardiovascular events and improving life expectancy.
Physiotherapy Management: In all the musculoskeletal and neurological conditions, physiotherapy plays a vital role in returning people to normal levels of health and well being. A combination of active and passive exercises, mechanical and electrical aids are used to improve and maximize the function. It offers various effective, non pharmacological approaches for pain relief.
TENS- is the transcutaneous electrical nerve stimulation. It is the application of the pulsed rectangular wave current via surface electrode on the patients skin. It is a useful method of removing pain in chronic pain syndromes. Also has an effect on blood flow and autonomic nervous system. Helps in reduction of oedema.
IFT (Inter Ferential Therapy ) - is a form of electrical treatment in which two medium frequency currents are used to produce low frequency effects. It helps in:-
• Pain relief
• Motor stimulation
• Absorption of exudates (Decreases swelling )
TENS and IFT are considered as Gold Standard therapies for the relief of neuropathic pain and have proven their benefits in the management of above complications related to diabetes. Inspite of these benefits- safety, lack of drug interactions, efficacy and cost are associated with these methods. Some centres have adopted TENS/IFT as primary treatments for painful diabetic neuropathy.
Corrective measures: In managing foot problems also, physiotherapists plays an important role by teaching the importance of correct gait and posture along with the basic principles of off loading when required, can prevent number of foot complications with trophic ulcers. The effective use of crutches or foot splints can ensure off loading and early healing. In people who are unfortunate enough to undergo an amputation, the physiotherapists helps with post operative pain relief, rehabilitation, limitation of disability and the optimum use of prosthesis.
So, as the number of people with diabetes continues to rise and as the existing diabetes population ages, the need for efficient physiotherapy services will continue to grow. Including specialized physiotherapists as equal members of the diabetes care team will help us to utilize their services effectively, in order to improve the health and well being of all people with diabetes.
 

Lecturer,
DAV Institute of Physiotherapy,
Mahatma Hans Raj Marg, G.T. Road,
Jalandhar-144008 (Pb.)