Physiotherapy-Led Exercise Approaches for Optimizing Glycemic Control in Type 2 Diabetes Mellitus: A Narrative Review

Type 2 Diabetes Mellitus (T2DM) continues to surge globally, with projections indicating an estimated 783 million affected adults by 2045. Maintaining optimal glycemic control, frequently monitored by glycated hemoglobin (HbA1c) levels, is vital for minimizing diabetes-related complications. While exercise intervention remains a cornerstone of T2DM management, patient adherence and individualized program design present persistent challenges. This narrative review synthesizes evidence from recent controlled trials, systematic reviews, and guidelines to highlight the unique contribution of physiotherapist-led exercise programs for adults with T2DM. Focus is placed on the efficacy of aerobic, resistance, and combined exercise modalities, with an emphasis on the role of supervision and long-term outcomes. Findings indicate that professionally supervised exercise, particularly when guided by physiotherapists, can improve HbA1c by 0.5%–1.0% within 12–24 weeks, showing benefits than rival pharmacological treatment. Physiotherapist involvement enhances adherence, safety, and personalization of therapy, making them indispensable members of diabetes care teams. Larger, longer-term randomized controlled trials are warranted to confirm these outcomes and to investigate digital and cost-effective physiotherapy solutions.