1. Overall introduction

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by an increase in the blood-glucose level resulting from a relative insulin deficiency or insulin resistance or both. It is a growing public health problem and is considered as one of the main threats to human health in the twenty-first century. It imposes a significant burden on patients and society [1–3]. It is one of the leading causes of complexity of the illness, an increased risk of medical comorbidities like fatigue, recent weight loss, severe restriction in mobility and strength and increased propensity to falls [4, 5].

According to the Centers for Disease Control, about 26 million children and adults are living with diabetes. In addition, almost 79 million people have "pre-diabetes". The overall magnitude of DM in adults older than 20 years was estimated as 171 million in the year 2000. The

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

prevalence will likely to be twice as much as the current prevalence by the year 2030. The type 2 diabetes mellitus is the most common type of diabetes and accounts for 90–95% of overall diabetes cases [5, 6]. The number of adults with DM in the world elevated from 108 million to 422 million between 1980 and 2014 [7].

Active and passive range of motion exercises, stretching techniques, strengthening and aerobic exercises are some of the physical therapy management techniques for the inpatients, outpatients and prediabetes. These physiotherapy treatments help patients to regain normal range of motion, muscle strength, endurance and physical functioning. It can also maximize the level of independence of DM patients during mobility and activities of daily living. Ultimately,

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physical therapy aims to improve the health-related quality of life of DM patients [12].

2. The diabetic care pathway and general concept of physical therapy

It is the right of people with diabetes mellitus to expect a timely, accessible and of uniformly high-quality care. However, diabetes care is complex and multidirectional due to their multifaceted needs [13–16]. It should be delivered in a wide range of clinical settings by healthcare professionals from diverse backgrounds and with diverse skills. The diabetic care pathway improves the delivery of effective care, facilitate critical evaluation of that care and strengthen multidisciplinary communication [17]. They promote a uniform standard of care delivery in a

Physical therapists must undergo assessment based on the International Classification of Functioning, Disability and Health (ICF) model before, during and after physical therapy for each diabetic patient (Figure 3). ICF enables physical therapists to identify and analyze problems to provide diabetic patients with therapy. Diabetic patients have many problems caused by diabetes itself and its associated complications. Physical therapy assessment should include

2.1. The diabetic care pathway

wide variety of clinical settings (Figure 2).

2.2. General concept of physical therapy

Figure 2. The integrated diabetes care pathway.

As the diabetes epidemic grows 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, people with DM need to have an integrated and interdisciplinary rehabilitation team consisting a range of healthcare personnel, including physiotherapists, psychologists and eye specialists. Diet, medication, physical activity and education play a significant role for the prevention, rehabilitation and self-management of diabetes mellitus [5, 8, 9].

Most individuals with diabetes mellitus will visit a physical therapist in the multidisciplinary clinic where they receive care for their DM-related problems. Physical therapists are professionally allowed to exercise in several treatment settings including acute care, nursing home and inpatient and outpatient rehabilitation settings. Physical therapists also work in conjunction with the rehabilitation team to design components of community-based rehabilitation strategy so as to enhance physiological, anatomical and psychosocial outcomes [10] (Figure 1).

Physical therapy is a thus corner stone of prevention and treatment of diabetes mellitus. Physical therapy-directed movement and exercise programs are clinically effective in helping diabetic patients to produce the desired health-related quality of life (HRQOL) outcomes [11].

Figure 1. The multidisciplinary rehabilitation team approach centres on the patient and caregiver.

Active and passive range of motion exercises, stretching techniques, strengthening and aerobic exercises are some of the physical therapy management techniques for the inpatients, outpatients and prediabetes. These physiotherapy treatments help patients to regain normal range of motion, muscle strength, endurance and physical functioning. It can also maximize the level of independence of DM patients during mobility and activities of daily living. Ultimately, physical therapy aims to improve the health-related quality of life of DM patients [12].
