How can PTs and OTs help people recently diagnosed with this widespread condition?
If you live in the United States, there’s a good chance that diabetes impacts you in some way. In America, the chronic illness is common enough that it’s rare to find someone who doesn’t have a connection to the disease.
Yet unless it impacts a person or family directly, it’s unlikely that their knowledge of diabetes goes far beyond blood sugar measurement and insulin therapy.
However, as the seventh-leading cause of death in the United States, diabetes isn’t an illness that should be so easily overlooked.1 In 2012, approximately 29.1 million Americans, or 9.3% of the population, were living with diabetes. Of that total, 8.1 million were undiagnosed.
Despite advances in treatment, those numbers are unlikely to decrease in the coming years: Annually, 1.4 million Americans receive a diabetes diagnosis. There is no cure.2
The good news is that diabetes can be treated and controlled. From exercise to medication to healthy eating, many options are available for individuals with diabetes who are looking to maintain or improve their health.
November is Diabetes Awareness Month, and although many individuals living with diabetes are unaware, physical and occupational therapists are well-equipped to help people long before the illness causes serious side effects. In fact, partaking in these therapies can potentially prevent these consequences altogether.
Caitlin Burbank, PT, DPT, of Northwest Rehabilitation Associates Inc. in Wharton, N.J., estimates that 15-20% of the patients she sees have diabetes – but she typically doesn’t meet them until long after diagnosis.
“Unfortunately, many patients are not aware or educated on the role physical therapy can play in the management of diabetes early on in the diagnosis,” Burbank explained. “Most often, patients are referred to address the effects of poor management of their health condition, leading to stroke, amputation or neuropathy.”
Despite typically not encountering patients until years into their journeys with diabetes, Burbank’s practice has had tremendous success working with these individuals. The practice’s Diabetic Exercise class occurs over a period of six weeks, during which 8-10 people with diabetes work with two physical therapists to acquire skilled care and the information necessary for independent diabetes management.
After an initial evaluation of each participant, the class starts off with a session highlighting education on the role of exercise in diabetes management, specifically recommendations for exercise duration, type and intensity, as well as individualized exercise parameters. For the rest of the 6-week period, the class is structured to include four types of intervention: endurance training, strength, balance and power/intervals. At the conclusion of the program, each participant is re-evaluated in each of these four realms.
“As physical therapists, we are uniquely qualified to both educate our patients further on this diagnosis as well as create a long-term plan to promote physical health and mobility,” Burbank said. “Often, we only see people in the clinic once the sequelae of diabetes have set in. For example, we may see a patient for a diagnosis of peripheral neuropathy, caused by uncontrolled diabetes, leading to balance deficits and falls. With early education and intervention, it may be possible to either delay or possibly prevent these types of issues.”
Chantelle Rice, CDE, OTD, OTR/L, associate professor of clinical occupational therapy at the University of Southern California and director of the USC Occupational Therapy Faculty Practice at the Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, knows through her work as an occupational therapist and a certified diabetes educator how crucial early intervention is for individuals with diabetes.
At her practice, the OT team helps patients recently diagnosed with diabetes make the crucial lifestyle changes that will keep them happy and healthy.
First used during the mid-1990s as part of the Well Elderly studies spearheaded by Florence Clark, PhD, OTR/L, FAOTA, the Lifestyle Redesign program seeks to engage patients in health-promoting habits and routines in order to optimize health, function and emotional well-being. After the Well Elderly studies showed the success of the program with older adults, the program began to be used for weight management and management of various chronic diseases, including diabetes.
“Diabetes is a complex chronic condition,” Rice said. “It affects many areas of occupational performance. It could be that, with the diagnosis of diabetes, people need to begin to engage in new daily activities such as meal planning and preparation, physical activity and medication management. On the other hand, diabetes can affect engagement in daily activities and make it more difficult for people to do the things that they were doing before diagnosis. We’re addressing both development of new routines and modifying previous activities so that the patient can continue to engage in them.”
Rice stated that the Lifestyle Redesign program offers a form of occupational therapy that isn’t what individuals with diabetes typically are able to pursue – but it’s just as important, if not more.
“You’ll usually find OTs providing services for individuals diagnosed with diabetes in areas like rehabilitation after issues that result from diabetes,” Rice explained. “From a lifestyle standpoint, there aren’t as many occupational therapists providing those services.”
The Lifestyle Redesign program is similar to the Diabetic Exercise class at Burbank’s practice in that it heavily focuses on helping patients become independent and to maintain that independence. While Rice knows that she can help patients while they’re in the program, her goal is for those patients to be able to help themselves.
When Rice meets with a patient who was recently diagnosed with diabetes, she begins with an evaluation of the patient’s current habits and routines, including medical history, date of diagnosis, prescribed medications and the management of those medications, blood sugar measurement, eating routines, exercise routines and management of stress, anxiety and depression, if applicable.
From there, Rice works to determine what a “typical day” would be for each patient, focusing on “self-care behaviors” such as time management, leisure activities and home management, and how diabetes management can be included into that routine. “We really believe that all of these different self-care behaviors influence one another,” she said.
Responsibility of Rehabilitation
Burbank and Rice acknowledge that individuals with diabetes are typically referred to physical or occupational therapy by their physicians and rarely pursue the treatment on their own. However, it’s largely due to the fact that many people who were recently diagnosed with diabetes don’t know that they can already greatly benefit from these therapies.
“Unfortunately, many patients are not aware or educated on the role physical therapy can play in the management of diabetes early on in the diagnosis,” Burbank said. “I would encourage anyone with a diagnosis of diabetes to either seek out a skilled therapy consult or participate in a community-based class for preventative care.”
“A lot of the responsibility falls on the occupational therapy practitioners to be knowledgeable and ready to address this specific chronic condition,” Rice agreed. “It doesn’t really matter what setting you’re in.”
- U.S. Centers for Disease Control and Prevention. Leading causes of death. 2014.
- American Diabetes Association. Statistics about diabetes. 2016.