Is Massage Useful in the Management of Diabetes?
November is Diabetes Awareness Month. The health benefits of massage are varied, but can it help in the management of diabetes? Find out what’s proven to work best, and what should you know about massage therapy for diabetes.
As more Americans incorporate CAM modalities into their health care, people with diabetes are also looking to complement their lifestyle with integrated medical care. Massage Therapy is a commonly-used modality for patients with diabetes. Learn how it can help you or a loved one with diabetes.
Abstract in Brief
Massage is among the fastest growing CAM therapies used in the United States. Here we present a brief review of the available evidence on potential benefits and adverse effects of massage for people with diabetes: Massage at injection sites may increase insulin absorption; uncontrolled studies suggest that massage may have a positive effect on blood glucose levels and symptoms of diabetic neuropathy; randomized, placebo-controlled studies are needed to confirm any short- and long-term benefits of massage as a complementary treatment for diabetes and to further define an optimal massage treatment.
This article aims to clarify what is and is not known about the use of Massage Therapy for people with diabetes, with 4 frequently asked questions.
1. Can Massage Improve Insulin Absorption?
Our search found one study on insulin absorption in Type 1 diabetes. No studies were found on insulin absorption in Type 2 diabetes. Dillon observed that eight lean, well-controlled patients with Type 1 diabetes who massaged their insulin injection sites with an electric vibrator for 3 minutes at 15 minutes post-injection, experienced higher insulin levels and lower serum glucose levels by 15 minutes after the start of massage and 29 minutes post-injection, but these changes were not statistically significant. More significantly, serum glucose levels fell 8.3% lower (P < 0.05) 30 minutes after massage and 44 minutes post-injection compared to the control day when participants did not massage their injection sites. At 45 minutes post-massage, the difference in glucose levels was even more striking (76 mg/dl ± 6%) when compared to the control day (89 mg/dl ± 4%).
The same report revealed 2-year follow-up data on these eight patients, as well as on 18 others who had been massaging their injection sites for 3 minutes at each meal in order to achieve a beneficial postprandial rise in insulin levels. After 3–6 months of massage, the mean HbA1 for the 26 patients fell from 10.56 ±1.73 to 8.55±1.69%. (Normal HbA1 was <8.2% according to the laboratory assay used.) After 12-18 months of injection-site massage, 8 patients had normal HbA1 levels, and the remaining 18 patients had mean HbA1 levels of 8.41 ±1.58%, a significant improvement from baseline (P < 0.001). Dillon proposed that injection-site massage can improve conventional insulin therapy by increasing the bioavailability of insulin in the postprandial state.
2. Can Massage Help Normalize Blood Glucose Levels?
Three published results of two trials and one unpublished preliminary study have examined the effects of massage on normalizing blood glucose.
Fields and colleagues, describing a single-group, pre/post-test design in two publications of the same study population, reported that after 1 month of parents administering nightly full-body massage to their diabetic children (n = 14), the children’s glucose levels decreased from an average of 158 to 118 mg/dl. The authors also reported that both parents’ and children’s anxiety and depression levels decreased immediately after massage.
Vest trained clinical staff to administer 15-minute sessions of breathing instruction, light touch and acupressure to diabetic patients for 6 consecutive weeks using a one-group, pre/post-test design (n = 12). Patients had a reduction in blood glucose, anxiety, headaches, depression, work stress and anger. Self-reports also indicated the patients were sleeping better and had improved family relations. No P values were cited.
Preliminary data were available from one small trial comparing people with Type 2 diabetes receiving 45-minute full-body massage three times a week for 12 weeks (n = 6) to similar patients on a waiting list for massage (n = 2). Researchers found that of the 6 patients receiving massage, HbA1c decreased in 3 patients from a baseline of 7.9, 8.3, and 9.8% to 7.3, 8.1, and 8.6%, respectively. In the other three patients receiving massage, HbA1c increased from a baseline of 7.4, 8.2, and 8.0% to 7.9, 10.0, and 8.5%, respectively. These patients, whose glycemic control deteriorated while receiving massage, were obese, injecting insulin, or both. None of the group whose glycemic control improved with massage had either of these characteristics. In the waiting list control group, HbA1c level also declined from 7.3 and 8.6% to 6.9 and 8.4%, respectively.
3. Can Massage Provide Relief for Symptoms Associated With Diabetic Neuropathy?
Our search found one trial assessing the effects of massage on the symptoms of diabetic neuropathy. This single-group, pre/post-test design assessed 25 patients with symmetrical diabetic neuropathy of the lower extremities and complaints of burning, tingling, pain, itching, restless legs, paresthesia and loss of reflexes. The duration of disease was 6–17 years, and the duration of neuropathic symptoms averaged 14 months. Massage was administered every 2 days, with the total number of treatments ranging from 20 to 30 in those who appeared to benefit. Therapy was discontinued after the tenth treatment for those who experienced no benefit.
Subjective outcomes were defined as no effect, improved or good. At the 1-month follow-up, results showed good response in 14 cases (56%), improvement in 8 cases (32%), and no effect in 3 cases (12%).
Question #4: What Contraindications or Precautions Are Related to Massage for People With Diabetes?
A potential adverse effect of massage for diabetes appears to be the risk of inducing hypoglycemia in insulin-using patients. This risk is extrapolated from massage studies using healthy volunteers. None of the studies of massage and diabetes reports adverse effects.
In the study of massage for diabetic neuropathy, Kurashova specifically cites contraindications and precautions for people with diabetes. In the beginning, it is recommended to use only continuous effleurage. Massage should begin with 5-7 minutes on the back, then proceed to the posterior thigh and calf. 20-30 minutes total on the posterior body; then 10–15 minutes on anterior extremities. For patients with peripheral nerve damage, gentle friction of the lower extremities can be added only after 7–10 treatments of effleurage have been completed.
Because vascular dysfunction may render the tissues fragile, friction should be light to avoid vascular damage or bruising. In swollen areas, friction should be avoided because the direct pressure into the tissues that is characteristic of friction may further close the dysfunctioning vessels. Pressure should be sufficiently light to cause no pain.
Massage at an insulin injection site can significantly increase serum insulin action, thereby decreasing blood glucose levels in people with Type 1 diabetes. It is unknown whether massage can improve insulin sensitivity and therefore be a useful adjunct to management of Type 2 diabetes.
Uncontrolled studies suggest that massage may help normalize blood glucose and symptoms of diabetic neuropathy. Randomized, placebo-controlled studies are needed to further clarify what an optimal massage treatment might be and to elucidate any short- and long-term benefits of massage as a complementary treatment for diabetes.