Opportunities and limitations of physical therapy methods in the comprehensive management of diabetic angiopathy

The present article provides a comprehensive analysis of the current epidemiology, pathogenesis, diagnostics, and therapeutic approaches for lower extremity macroangiopathies in patients with type 2 diabetes mellitus (DM). DM represents a significant medical and social challenge due to its high prevalence, continuing global growth, chronic progressive nature with cumulative complications, substantial rates of disability, and the associated demand for a specialized system of care. It is noted that the prevalence of DM type 2 and its macrovascular complications, including peripheral arterial atherosclerosis and ischemic heart disease, continues to rise, significantly impacting mortality and patients’ quality of life. The global number of adult patients with diabetes has exceeded 800 million, with up to 50% of them being of working age. Macroangiopathies markedly increase the risk of cardiovascular events and peripheral blood flow disorders. The pathogenesis of these microangiopathies is primarily driven by insulin resistance, chronic hyperglycemia, and specific forms of diabetic dyslipidemia. Clinical diagnosis of macroangiopathies is based on a comprehensive assessment of symptoms, physical examination, and instrumental methods. Treatment prioritizes risk factor modification, pharmacotherapy, as well as non-pharmacological approaches including physical therapy modalities. Promising techniques such as laser therapy, low-frequency electrical stimulation, and vacuum therapy are highlighted for their role in improving microcirculation. The authors emphasize that a multifactorial strategy, integrating modern pharmacological and physical methods alongside regular clinical monitoring, forms the foundation for effective rehabilitation and prevention of severe vascular complications in patients with DM.

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