ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 35 of 55
УЖМБС 2022, 7(5): 225–231
Physical Therapy and Ergotherapy

Effectiveness of Body Weight Correction as a Part of Rehabilitation Program in Patients with Type 2 Diabetes Mellitus Combined with Obesity and Chronic Pancreatitis

Prokopchuk V. Yu. 1, Sharapa G. F. 1, Kopanytsia O. M. 1, Hevko U. P. 2, Marushchak M. I. 2

The purpose of the study was to analyze the impact of a physical exercise program and therapeutic massage as a part of rehabilitation program in patients with type 2 diabetes mellitus combined with obesity and chronic pancreatitis on carbohydrate metabolism. Materials and methods. 579 patients with type 2 diabetes mellitus with overweight / obesity and concomitant chronic pancreatitis were included in the study. According to the analysis of the medical case histories, patients took metformin in the minimum dose that ensured the effectiveness and maximum tolerability of the drug, which was 1500-2000 mg/day. Combined therapy, which was taken by some patients, included: metformin and sulfonylurea derivatives in effective therapeutic doses. Against the background of the prescribed therapy, in the post-hospital period, rehabilitation programs were offered, which included a program of physical exercises and therapeutic massage, during 1 month. Results and discussion. It is likely that patients with type 2 diabetes mellitus, regardless of body mass index and the presence of chronic pancreatitis, received combined therapy. At the same time, the largest percentage of patients on combined therapy was recorded with type 2 diabetes mellitus and chronic pancreatitis. Both the use of metformin in the form of monotherapy and the use of combined therapy (metformin and gliclazide) in the condition of patients only with type 2 diabetes mellitus and with a comorbid type 2 diabetes mellitus with chronic pancreatitis and increased body weight / obesity do not allow reaching the target levels of glucose and HbA1c. It was established that the number of patients with type 2 diabetes mellitus without comorbidity who received mono- and combined therapy in combination with a complex of rehabilitation measures reached the target HbA1c indicators. It is also worth noting the increase in the number of insufficiency with type 2 diabetes mellitus combined with overweight / obesity and chronic pancreatitis, indicating the effectiveness of the proposed rehabilitation measures. Conclusion. The additional appointment in the post-hospital period of a complex of rehabilitation program, which includes physical exercises and therapeutic massage, contributed to the achievement of the target level of HbA1c in type 2 diabetes mellitus without comorbidity in 72.73% of patients with monotherapy and in 63.41% with combined therapy and with the associated course of diabetes mellitus, overweight / obesity and pancreatitis, respectively, in 37.62% and 38.28%

Keywords: type 2 diabetes mellitus, obesity, chronic pancreatitis, treatment, physical exercises, therapeutic massage, effectiveness

Full text: PDF (Ukr) 263K

  1. Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14(2):88-98. PMID: 29219149.
  2. Hevko UP, Marushchak MI. Polymorphisms of insulin receptor substrate 1 as a risk factor for type 2 diabetes mellitus, obesity and chronic pancreatitis among population of Ternopil region. Int J Medicine Med Res. 2020;6(2):30-36.
  3. Hosseini S, Alipour M, Zakerkish M, Cheraghian B, Ghandil P. Effects of epigallocatechin gallate on total antioxidant capacity, biomarkers of systemic low-grade inflammation and metabolic risk factors in patients with type 2 diabetes mellitus: the role of FTO-rs9939609. Arch Med Sci. 2020 Jun 8;17(6):1722-1729. PMID: 34900054. PMCID: PMC8641491.
  4. International Diabetes Federation. IDF Diabetes Atlas 9th edition 2019. International Diabetes Federation. 2020 Aug 21.
  5. Blüher M, Stumvoll M. Diabetes and Obesity. In: Bonora E, De Fronzo R, Eds. Diabetes Complications, Comorbidities and Related Disorders. Endocrinology. Springer, Cham; 2018.
  6. Jensen MD, Ryan DH, Donato KA, Apovian CM, Ard JD, Comuzzie AG, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines, Obesity Expert Panel, 2013. Executive summary: Guidelines (2013) for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society published by the Obesity Society and American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Based on a systematic review from the Obesity Expert Panel. 2013. Obesity (Silver Spring). 2014 Jul 22;2(2):5-39. PMID: 24961825.
  7. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, et al. Obesity Management Task Force of the European Association for the Study of Obesity. European Guidelines for Obesity Management in Adults. Obes Facts. 2015;8(6):402-24. PMID: 26641646. PMCID: PMC5644856.
  8. Han TS, Wu FC, Lean ME. Obesity and weight management in the elderly: a focus on men. Best Pract Res Clin Endocrinol Metab. 2013 Aug;27(4): 509-25. PMID: 24054928.
  9. ADA. American Diabetes Association. Standards of Medical Care in Diabetes - 2019 abridged for primary care providers. Clin Diabetes. 2019;37(1):11-34. PMID: 30705493. PMCID: PMC6336119.
  10. Conwell DL, Lee LS, Yadav L, Longnecker DS, Miller FH, Mortele KJ, et al. American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: evidence-based report on diagnostic guidelines. Pancreas. 2014;43(8):1143-1162. PMID: 25333398. PMCID: PMC5434978.
  11. Nakaz MOZ Ukrainy № 638 vid 10.09.2014. Pro zatverdzhennya ta vprovadzhennya medyko-tekhnolohichnykh dokumentiv zi standartyzatsiyi medychnoi dopomohy pry khronichnomu pankreatyti [On the approval and implementation of medical and technological documents on the standardization of medical care for chronic pancreatitis]. [Ukrainian]. Available from:
  12. Body Mass Index: Considerations for Practitioners. Available from:
  13. Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;61:2461-2498. PMID: 30288571.
  14. Unifikovanyi klinichnyi protokol pervynnoi ta vtorynnoi (spetsializovanoi) medychnoi dopomohy tsukrovyi diabet 2 typu [Unified clinical protocol of primary and secondary (specialized) medical care for type 2 diabetes]. 2012. [Ukrainian]. Available from:
  15. Tronko ND, Efimov AS, Tkach SN. Peroralnye sakharosnizhayushchie preparaty i taktika ikh primeneniya [Oral sugar-lowering drugs and tactics of their application]. K: Zdorove; 2002. 110 s. [Russian]
  16. American Diabetes Association. Standards of medical care in diabetes - 2018. Diabetes Care. 2018;41(1):1-159. PMID: 30135199.
  17. Villareal DT, Aguirre L, Gurney AB, Waters DL, Sinacore DR, Colombo E, et al. Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults. N Engl J Med. 2017 May 18;376(20):1943-1955. PMID: 28514618. PMCID: PMC5552187.
  18. Villareal DT, Aguirre L, Gurney AB, Waters DL, Sinacore DR, Colombo E, et al. Aerobic or resistance exercise, or both, in dieting obese older adults. N Engl J Med. 2017 May;376(20):1943-55. PMID: 28514618. PMCID: PMC5552187.
  19. Dashti S, Dabaghi P, Tofangchiha S. The effectiveness of training program based on protective motivation theory on improving nutritional behaviors and physical activity in military patients with type 2 diabetes mellitus. J Family Med Prim Care. 2020 Jul 30;9(7):3328-3332. PMID: 33102291. PMCID: PMC7567268.
  20. Lyu WB, Gao Y, Cheng KY, Wu R, Zhou WQ. Effect of self-acupoint massage on blood glucose level and quality of life in older adults with type 2 diabetes mellitus: a randomized controlled trial. J Gerontolog Nurs. 2019;45(8):43-48. PMID: 31355898.
  21. Donoyama N, Suoh S, Ohkoshi N. Adiponectin increase in mildly obese women after massage treatment. J Altern Complement Med. 2018;24(7):741-742. PMID: 29641244.
  22. Zhang X, Cao D, Yan M, Liu M. The feasibility of Chinese massage as an auxiliary way of replacing or reducing drugs in the clinical treatment of adult type 2 diabetes: a systematic review and meta-analysis. Medicine (Baltimore). 2020;99(34):e21894. PMID: 32846852. PMCID: PMC7447487.