Physical Therapy Reduced the Risk of Microvascular Complications in the Musculoskeletal Disorders Population with Type 2 Diabetes Mellitus.

Abstract

To investigate whether active physical therapy (PT) reduces the risk of microvascular complications in patients with type 2 diabetes mellitus (T2DM) and musculoskeletal disorders (MSKDs). Retrospective population-based cohort study using Taiwan's National Health Insurance claims data with inverse probability of treatment weighting (IPTW). A nationwide population-based setting. 8,857 adults diagnosed with T2DM and MSKDs between 2000 and 2021. Participants were grouped into 1,111 receiving active PT and 7,746 receiving passive PT based on receiving ≥50% of the respective modality type in their PT claims. Active PT included structured exercise-based modalities (e.g., strengthening, aerobic, balance training). Passive PT involved modalities requiring minimal patient effort (e.g., thermotherapy, ultrasound). The primary outcome was the incidence of diabetes-related microvascular complications (peripheral neuropathy, retinopathy, and nephropathy). After IPTW adjustment, active PT was associated with a reduced risk of microvascular complications (adjusted HR: 0.871; 95% CI: 0.794-0.954), particularly for peripheral neuropathy (adjusted HR: 0.828; 95% CI: 0.724-0.947). The per-protocol population of active PT conferred the greatest benefit (adjusted HR: 0.659; 95% CI: 0.518-0.837). No significant differences were observed for retinopathy or nephropathy. Subgroup analyses showed stronger effects in women and those with hypertension or hyperlipidemia. In patients with T2DM and MSKDs, active PT was associated with a lower risk of diabetic peripheral neuropathy. Structured exercise-based PT may offer preventive benefits beyond musculoskeletal care and should be considered in diabetes management strategies.