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Objectives: Massage therapy has been used since ancient times for many diseases. This systematic review aimed to evaluate the effectiveness of massage therapy on the symptoms and complications of diabetes mellitus (DM). Methods: Three electronic databases including PubMed, Google Scholar, and Scopus were searched from January 1, 2000 to May 13, 2018 using relevant keywords, followed by identifying all relevant randomized controlled trials. The study design, interventions, controls, primary outcome measures, follow-up, and main results were extracted and methodological quality was evaluated using the Jadad Scale by two authors independently. Results: Significant results were obtained, including a decrease in blood glucose, hemoglobin A1c (HbA1c) levels while an improvement in neuropathic pain and diabetic foot ulcer in the related articles. Conclusions: From this review, massage therapy can affect the clinical and laboratory symptoms and complications of the DM. However, various conditions such as the quality and quantity of pressure and duration, as well as the number of sessions, the type of massage, and the psychophysical state of patients can change the results of massage therapy. Keywords: Dalk, Diabetes, Massage, Persian traditional medicine, Ziabites
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The Effect of Massage on Diabetes and its Complications: A
Systematic Review
Introduction
According to the report of the World Health Organization,
although diabetes mellitus (DM) has been known
from 3000 years ago and various therapies have been
experienced in this respect, it was the fourth cause of
death in non-communicable diseases in 2016 (1,2).
Many countries have used massage therapy from
ancient times, including Babylonia, Assyria, Iran, India,
China, Egypt, Syria, Greece, America, Australia, Africa,
and Europe. It can be found in Egyptian papyrus (1700
BC), Chinese medical book (2700 BC), the writings
of Hippocrates (357-460 BC), as well as Avicenna and
Ambroise Paré in the 10th century and 16th century AD
(3-5).
Some studies (6, 7) about diabetes and Iranian traditional
medicine reported that Ziabites (DM in Iranian traditional
medicine) is treated by herbal therapy and sometimes
with moderate Dalk (massage).
Over the last few decades, the non-drug treatment
of diabetes has received special attention (8,9). For
example, 80% of people in developing countries use
complementary/alternative medicine. This trend in
diabetics is 2.5 times more than non-diabetics (10,11).
In recent years, the beneficial effect of massage therapy
has been confirmed for some diseases such as arthritis,
fibromyalgia, hypertension, asthma, multiple sclerosis,
and breast cancer (12) while the effect of massage on DM
has been categorized in the lowest documented group in
the review article by Ng and Cohen (13). There is only
one systematic review for the effectiveness of massage on
the DM in the latest two decades which has unclarified
conclusions (14). After 2 decades, the role of massage
therapy on DM remains unknown. Accordingly, this
systematic review sought to find if a massage has any effect
on the treatment and complications of the DM compared
to current treatments.
Methods
Two independent researchers searched PubMed, Google
Scholar, and Scopus databases from January 1, 2000, to
May 13, 2018.
The search terms were “massage”, “Dalak”, and “Dalk,
that were combined with other terms including “diabetes
mellitus”, “ziabites, “blood glucose”, “DM complications”,
“hyperglycemia, “T2DM”, and “T1DM” by using Boolean
operators in the title and abstract based on the MESH/
Abstract
Objectives: Massage therapy has been used since ancient times for many diseases. This systematic review aimed to evaluate the
effectiveness of massage therapy on the symptoms and complications of diabetes mellitus (DM).
Methods: Three electronic databases including PubMed, Google Scholar, and Scopus were searched from January 1, 2000 to May
13, 2018 using relevant keywords, followed by identifying all relevant randomized controlled trials. The study design, interventions,
controls, primary outcome measures, follow-up, and main results were extracted and methodological quality was evaluated using
the Jadad Scale by two authors independently.
Results: Significant results were obtained, including a decrease in blood glucose, hemoglobin A1c (HbA1c) levels while an
improvement in neuropathic pain and diabetic foot ulcer in the related articles.
Conclusions: From this review, massage therapy can affect the clinical and laboratory symptoms and complications of the DM.
However, various conditions such as the quality and quantity of pressure and duration, as well as the number of sessions, the type
of massage, and the psychophysical state of patients can change the results of massage therapy.
Keywords: Dalk, Diabetes, Massage, Persian traditional medicine, Ziabites
Open Access Review Article
Crescent Journal of Medical and Biological Sciences
Received 16 November 2018, Accepted 20 March 2019, Available online 5 April 2019
1Student of Traditional Persian Medicine, School of Traditional Persian Medicine, Qom University of Medical Sciences, Qom, Iran.
2Neuroscience Research Center, Department of Epidemiology and Biostatistics, Faculty of health, Qom University of Medical Sciences,
Qom, Iran. 3Department of Endocrinology, School of Medicine, Qom University of Medical Sciences, Qom, Iran. 4Department of Information
Science & Knowledge Studies, Qom University of Medical Sciences, Qom, Iran. 5Department of Traditional Persian Medicine, School of
Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 6Department of History of Medicine, School of Traditional Persian
Medicine, Tehran University of Medical Sciences, Tehran, Iran. 7School of Traditional Persian Medicine, Qom University of Medical Sciences,
Qom, Iran.
*Corresponding Author: Majid Asghari, Tel: +989126452669, Email: Asghari.rall@gmail.com
http://www.cjmb.org
eISSN 2148-9696
Vol. 7, No. 1, January 2020, 22–28
Davood Bayat1
ID
, Abolfazl Mohammadbeigi2, Mahmoud Parham3, Akram Mehrandasht4, Mamak Hashemi5,
Kamran Mahlooji6, Majid Asghari7*
ID
Bayat and Asghari
Crescent Journal of Medical and Biological Sciences, Vol. 7, No. 1, January 2020 23
subject. The English and Persian articles were used in
this study and the methodological quality of all included
randomized controlled trials (RCTs) was assessed by
using the Jadad Scale. In addition, the studies were
independently selected and assessed by two investigators
(D.B. and M.A) using the Jadad scale. Duplicate studies
were excluded using Mendeley software as well. Further,
irrelevant studies were excluded after accessing the title and
abstract, followed by excluding some other studies after
accessing to all contents of the studies. According to PICO
( patient, intervention, comparison, and outcome) criteria,
the included literature must be an RCT that evaluates the
effect of any type of massage on signs, symptoms, or the
complications of the DM (type 1 or type 2) compared with
placebo or standard treatment with Jadad scale ranging
from 3 to 5. The outcomes compromise clinical changes,
laboratory tests, and the quality of life evaluation.
In the present study, the exclusion criteria were studies
with uncertain statistical information and vague results, as
well as the irrelevant outcome of trials with DM signs and
symptoms or its complications and other manipulations
such as reflexology, acupressure, Yumeiho therapy, and
chiropractic.
The key data (i.e., patients, interventions, controls,
outcomes, aims, and Jadad scale) were extracted from all
included RCTs (Table 1). The protocol of this systematic
review was according to the PRISMA-P (Preferred
Reporting Items for Systematic Review and Meta-analysis
Protocols) 2015 checklist.
Results
A total of 1086 records were retrieved from the search
strategy, including data from PubMed (n = 820), Google
Scholar (198), and Scopus (68). Duplicate records were
removed (237 titles) by Mendeley software, followed by
excluding irrelevant studies (823 titles), and finally, a total
of 26 articles were selected for full-text review. Eventually,
the quality evaluation was conducted on 12 articles that
met the inclusion criteria. Figure 1 is a flowchart of the
study selection process.
Interventions and Controls
All studies included two massage and control groups and
only one study had massage, relaxation, and cont rol groups
(15). Different types of massages were done in intervention
groups, including tactile (superficial) massage (TM),
Table 1. Study Characteristics
Author Aim Massage/Control Variables Jadad
Scale
Wändell et al18 Effect of TM on metabolic control (T2DM) TM/music CD
FPG (FBS), HbA1c, insulin, CRP, TNF-alpha,
Interleukin- 6, Adiponectin, Leptin, Ghrelin
Catecholamine's, cortisol HOMA2, and BMI
5
Wändell et al19 Effect of TM on HRQoL in T2DM TM/music CD SF-36 questionnaire (Swedish version) and BMI 5
Sajedi et al21 Effect of Swedish massage on blood glucose
level in T1DM children
Swedish massage/
conventional therapy FBS and BMI 3
Wändella and
Ärnlöv17 Effects of TM on T2DM laboratory tests TM/music CD
BMI, WC, W, H, FPG, HbA1c, IGF, insulin,
adiponectin, leptin, ghrelin, HOMA2–IR glucose /
insulin, adiponectin/leptin, adiponectin/HOMA–IR,
adiponectin/WC, and adiponectin/HbA1c
3
Ghazavi et al15 Effects of massage therapy and PMR on
HbA1c level in T1DM children
Massage/PMR/conventional
therapy HbA1c 3
Castro-Sánchez
et al22
Effects of CTM on blood circulation and
intermittent claudication in T2DM
CTM and exercise
(flexion, extension)/sham
magnetotherapy
SAP, HR, ST, OS, SBF, and BMI 3
Mars et al23 Effect of CAM on diabetic foot ulcers CAM/conventional therapy Ulcer size, vascular status, sensory changes, and
co-morbidities 3
Joseph et al23 Effect of CTM in diabetic foot ulcer (T2DM) CTM/conventional therapy PWAR BCC 3
Gok Metin et
al25
Effect of AM on neuropathic pain severity
and quality of life
Aromatherapy massage/
conventional therapy
NePIQoL, the VAS and neuropathic pain impact on
quality of life questionnaire 5
Yu et al26 Effect of traditional massage on FBS and
sugar tolerance of T2DM
Traditional massage+
Jiangtangling/Jiangtangling
(herbal drug)
FBS and insulin thirsty, debilitation, obesity, lose of
body mass, backache, and range of spinal 3
Ghasemipoor
et al16
Effect of TM on FBS, HBA1C in T2DM
women TM/ conventional therapy HbA1C and FBS 5
Boghrabadi
et al20
Effect of SM on some physiological factors
in T2DM women
Swedish massage/
conventional therapy
Glucose test, insulin resistance, HOMA-IR, Cortisol,
BP, PR, Adrenaline, weight, and height 3
Note. BCC, bacterial colonization count; BF, blood flow; BP, blood pressure; BSPP, blood sugar post prandial; CAM, compressed air massage; CM, Contact (tactile)
massage; CRF, cortico-releasing hormone; CTM, connective tissue manipulation; HR, heart rate; OS, oxygen saturation; PMR, progressive muscle relaxation;
PWAR, PWAR is the percentage difference in wound surface area (WSA) from baseline to the end of intervention and is calculated by Baseline WSA-final
WSA*100, Final WSA; SAP, segmental arterial pressure; SBF, skin blood flow; ST, skin temperature; TM, tactile massage; VAS, visual analog scale; WAR, wound
area reduction; BMI, body mass index; FPG, fasting plasma glucose; FBS, fasting blood sugar; T1DM, type 1 diabetes; T2DM, type 2 diabetes; HbAlc, glycated
hemoglobin A1c; HRQoL, health-related quality of life; NePIQoL, Douleur neuropathique questionnaire.
Bayat and Asghari
Crescent Journal of Medical and Biological Sciences, Vol. 7, No. 1, January 2020
24
Swedish massage (SM), connective tissue massage (CTM),
compressed air massage (CAM), aromatherapy massage
(AM), and Chinese (Tui-Na) massage (CM). The TM (16-
19), SM (15,20,21), and CTM (22,23) were used more than
the CAM (24), AM (25), and CM (26).
Comparatively, the routine conventional therapies were
the most commonly used type of therapy in control groups
(15,16,20,21,23-25) and the other therapies encompassed
music (17-19), progressive muscle relaxation (15),
traditional herbal therapy (26), and silent magneto
therapy (22). No article reported the quantity pressure of
massage on the surface.
All RCTs were done in adults except for 2 RCTs of T1DM
children (15,21). There was no gender predominance in
the RCTs except for two RCTs that were done in type 2
diabetic women (16,20).
The RCT contained 48 people in control or intervention
groups (22), and there were two RCTs with low sample
sizes including 10 and 12 people in each group,
respectively (20,23) whereas most of the included RCTs
had extremely average sample sizes (18-27 people in
control or intervention groups).
The body mass index (BMI) of the patients were not
specified in six articles (15,16,23-26). These studies
investigated the effect of massage on uncomplicated
diabetic patients (15-21,26), diabetic foot ulcer (23,
24), vascular and neurological complications (22), and
neuropathic pain (25), but no massage had an effect on the
other complications of the DM (e.g., cardiac, ocular, and
renal complications). In addition, T2DM was evaluated in
all RCTs except for two cases that completely had T1DM
(15, 21).
The retrieved outcomes can be divided into 2 groups
including the significantly changed variables and
non-significant, each of which has three subgroups of
laboratory, clinical, and quality of life (QoL) changes.
Further, the findings can be assessed according to the type
of massage.
The significant results presented in eight (15,16,19,21,23-
26) and four RCTs (17,18,20,22) had significant and non-
significant results. The significant results were fasting
plasma glucose (fasting blood sugar, FBS), BS2HPP (blood
sugar 2 hour post prandial), HbA1c (glycated hemoglobin
A1c), insulin, adiponectin, cortisol, adrenaline, waist
circumference, ankle-brachial index difference, changes
in segmental arterial pressure in the limbs, changes in
blood flow to the skin of the toe, as well as the reduced
duration of treatment for diabetic foot ulcer wound area
reduction (WAR), decreased neuropathic pain score, the
decreased index of the symptoms of thirst, disability,
obesity, decreased BMI, the recovery of back pain, and
spinal motor range (15-26). Finally, non-significant results
included HbA1c, FBS, serum insulin, insulin resistance,
heart rate (HR), blood pressure (BP) and the QoL
(17,18,20,22). More details are listed in Tables 1 and 2.
Presentation of the Outcomes According to Laboratory,
Clinical, and the Quality of Life Changes
1. Laboratory Changes
There was a significant decrease (P < 0.05, P < 0.05, and
P < 0.001) in the FBS after SM, CM, and TM (16, 21, 26)
while unchanged FBS was reported after the SM (20).
There was a significant decrease in serum insulin (P <
0.01), and BS2HPP (P < 0.05) after CM (26), whereas after
SM serum insulin was not changed (20).
According to Ghasemipoor et al study (16), a significant
decrease was also observed in the HbA1c (P < 0.05) after
the SM and TM (P < 0.001) but HbA1c revealed no
Records identified through database searching
(PubMed, n =820; Scopus, n= 68; Google
Scholar, n=820)
Retrieved records of 3 databases: 1086 records
Screening
Included
Eligibility
Identification
Records after duplicates removed
(n = 237)
Records screened
(n = 849)
Records excluded
(n = 823)
Full-text articles assessed
for eligibility
(n = 26)
Jadad scale < 3: 2
Other manipulations:
Acupressure (5),
Reflexology (7)
Studies included
(n = 12)
Figure 1. Study Flow Diagram.
Bayat and Asghari
Crescent Journal of Medical and Biological Sciences, Vol. 7, No. 1, January 2020 25
change after the TM in two studies.
Based on the results of other studies (17,18), increased
adiponectin (P < 0.01) and non-significant increasing of
adiponectin/leptin ratio after the TM compared to the
control group. There was a significant decrease in cortisol
and adrenaline (P < 0.05) after SM as well (20).
2. Clinical Changes
Similarly, there were decreased symptom index (i.e.,
thirsty, debilitation, obesity or losing of body mass,
backache, and the range of spinal motion) after the CM (P
< 0.01), decreased treatment duration of foot ulcers (P =
0.001) after CAM, and a reduction in neuropathic pain (P
< 0.001) after AM (24-26).
In another studies, significant changes were detected
in differential segmental arterial pressure (P < 0.05) and
skin blood flow (P < 0.05) (22) and a significant decrease
was observed in the WAR, bacterial colonization count
(BCC), and medium chain triglyceride (MCT, P < 0.05)
after CTM (23). On the other hand, CTM and SM failed
to change HR (22), and BP (20), respectively.
3. Quality of Life Changes
The QoL was evaluated in two RCTs (19, 25), which
improved significantly after TM (P = 0.02) and AM (P
< 0.04). These improved scales included the emotional
and physical scale of the QoL. The other RCTs failed to
evaluate the QoL.
Presentation of the Outcomes According to the Type of
Massages
TM: It was used in 4 RCTs for T2DM. One study
indicated a decrease in FBS and HbA1C (16) and 2 studies
demonstrated non-significant changes in HbA1C (17,
18). Moreover, TM caused decreased waist circumference,
improved adiponectin and adiponectin/leptin ratio (17,
18), and QoL improvement (19).
SM: It caused reduced FBS (21) and decreased HbA1C
(15) in 2 RCTs of T1DM. Additionally, it caused reduced
cortisol, pulse rate, and adrenaline in one RCT of T2DM
that had non-significant changes on BP, FBS, and the
serum level of insulin (20).
CTM: It was used in 2 RCTs of T2DM for DM
complications (i.e., claudication and diabetic ulcer),
leading to caused significant changes in differential
segmental arterial pressure and improvement of skin
blood flow (22) while a significant decrease in WAR, BCC,
and MCT (23). However, HR represented no change (22).
CM, AM, and CAM: Each of these massages had an
study. These studies indicated a significant improvement
in FBS, insulin, BS2HP, symptoms index (26), as well as
decreased neuropathic pain, QoL improvement (25), and
decreased treatment duration (24).
Discussion
Only one systematic review has previously evaluated the
effect of massage on diabetes in the two latest decades (14).
In their systematic review including 6 studies, Ezzo et al
(14) found that injected insulin absorption increased after
the massage, but they failed to clarify the effect of massage
on blood glucose and symptoms of diabetic neuropathy.
Similarly, Ng and Cohen in evidenced-based research
categorized the effect of massage on diseases from A to
E groups. In this category, diabetes was in
E group” and
had insufficient or no evidence (13) while new findings of
studies in the two latest decades help the presentation of
further documentation.
In this systematic review, 12 RCTs were studied
Table 2. Comparison of Findings of Included RCTs
Type of
Massage
Numbers of
RCTs
Sample Size:
Massage/Control Type of DM Significant Findings Non- significant Finding Reference
TM 4
23/24 T2DM HbA1C, FBS - (16)
21/25 T2DM Waist circumference HbA1C, adiponectin/
leptin (17)
22/23 T2DM Quality of life: Scale of role functioning, physical - (19)
26/27 T2DM Waist circumference, Adiponectin HbA1C (18)
SM 3
12/12 T2DM Cortisol, PR, Adrenaline BP, FBS, insulin (20)
25/25/25 T1DM HbA1C - (15)
18/18 T1DM FBS - (21)
CTM 2 10/10 T2DM WAR, BCC, MCT- (23)
48/46 T2DM SAP, SBF + HR (22)
CM 1 19/19* T2DM Insulin, FBS , BS2HPP, Symptoms index- (26)
AM 1 21/25 T2DM Neuropathic pain, quality of life - (25)
CAM 1 28/29 (T1DM, T2DM) Treatment duration (foot ulcer) - (24)
Note. TM, Tactile Massage; SM, Swedish massage; CTM, Connective tissue massage; CM, Chinese massage; AM, Aromatherapy massage; CAm, Compressed air
massage; RCT, randomized controlled trial; DM, diabetes mellitus; HbAlc, glycated hemoglobin A1c; FBS, fasting blood sugar; T1DM, Type 1 diabetes; T2DM,
Type 2 diabetes; WAR, wound area reduction; BCC: bacterial colonization count; MCT: medium chain triglyceride; PR: pulse rate; SAP, segmental arterial pressure;
SBF, skin blood flow; BP, blood pressure; HR, heart rate; BS2HPP, Blood sugar 2 hour post prandial.
Bayat and Asghari
Crescent Journal of Medical and Biological Sciences, Vol. 7, No. 1, January 2020
26
to evaluate the effect of massage on diabetes and its
complications. Although there was a plethora of significant
results, few unchanged variables or non-significant results
were reported in TM and SM. One RCT of TM decreased
HbA1C and FBS (16) while it failed to change HbA1c in 2
other RCTs (17,18). Likewise, 1 RCT of SM in T2DM failed
to change FBS and insulin (20) while FBS (21), and HbA1c
(15) in 2 other RCTs in T1DM demonstrated a decrease.
These discrepancies may arise from the different factors
such as the type of massages, the quality and quantity of
pressure in massages, the involved tissues in addition to
the duration and frequency of the massage session and
lubricant.
Superficial massage or TM is a light and gentle massage
through which only the skin is touched with low pressure
(27) whereas in SM muscles and connective tissues in
addition to skin are manipulated by five stages including
effleurage, petrissage, friction, tapotement, and vibration
(28).
The quantity and quality of pressure affect the results of a
massage. Significant differences and occasionally opposite
results are observed regarding moderate and light massage
in recent studies (29-32). The moderate and light pressures
of massage can reduce anxiety and moderate massage
can increase the delta wave in electroencephalogram
and parasympathetic activity whereas light massage can
reduce the delta wave and heighten the sympathetic
activity (29,30,33,34).
There are different types of Dalk (massage) in traditional
Persian medicine such as layen (flexible), solb (rigid),
amlas (soft), khashen (rough), and motadel (temperate)
which are used according to the temperament and physical
conditions of the patients (7,35-37). These types of Dalk
arise by combining three quality variables including
pressure, duration, and velocity as lightly, moderately, or
highly (3 qualities) in different forms (7,35). The Dalk is
a subgroup of movement and exercise that helps prevent
diseases and treat patients. In addition, it animates
instinctive heat which helps the reperfusion and the
elimination of waste materials. According to Avicenna
s
view, it is possible to achieve the opposite results of obesity
or slimming, as well as the stiffness or softness of the
organs by different types of Dalk. In other words, different
types of massage have different or opposite results (7).
The mechanoreceptors of the skin can be stimulated
by the light pressure of every strike in the TM. This
stimulation is transferred to different parts of cortex,
hypothalamus, and medulla by afferent sensory nerves
and C-fibers that can lead to hedonic feeling, autonomic
nervous system modulation, and some hormonal changes
such as adrenaline, noradrenaline, and cortisol (27,30,33,
38,39). These changes depend on the quality and quantity
of stimulations that arise the skin touch.
Other organs such as the muscles, tendons, vessels,
and nerves, along with the skin can be involved by light
to moderate pressure in the SM. Therefore, the range of
stimulations and their outcomes in the SM can be broader
compared to the TM such as its effectiveness in circulation,
removing venous return, and lymph drainage (40).
However, skin involvement in these two methods can
imply some similarities in their findings and the difference
in pressure and involved organs can reveal differences in
their outcomes. Contrarily, this hypothesis is correctly
insufficient to explain the discrepancies of findings in the
same massage in different studies.
CTM is done in the presence of skin-connective
tissue adhesion and limited on central areas such as the
sacrum, lower back, hip, chest, and ribs. Deep pressure
is recommended by detachment methods of skin and
connective tissue as well (41,42).
The method, quality of pressure, involved organs, and
the indication of the CTM differ from those of the SM and
TM. Further, the detachment of adhesion may be painful
and lead to analgesic system activation and the releasing of
endorphins in the nervous system (43). Furthermore, the
method of detachment, the stimulation of the autonomic
nervous system, and deep organ involvements in the
CTM may need moderate to high pressure. Moreover, the
endorphins and histamines releasing affect circulation and
immunity that accompanies therapeutic results (41,42).
According to positive findings, the CTM seems to be
suitable for diabetic complications such as diabetic foot
ulcer and intermittent claudication (22,23). Comparing the
effect of the CTM with the other massages was impossible
because infection and circulation status were evaluated
in the CTM while hormones, FBS, and its relative tests
were accessed in the others. There was only one RCT of
Chinese massage that succeeded in lowering insulin, FBS,
BS2HPP, and symptom index in T2DM. Chinese massage
or Tui-Na includes shaking, twisting, grasping, rubbing,
scrubbing, rotating, rolling, and vibrating which make
the Qi and the blood move and remove stagnation (44).
Similarly, stimulated acupoints on meridian canals during
the Chinese massage may be the other cause of its positive
findings that are neglected in the other types of massages.
It implies the importance of the involved tissue in massage
as well.
CAM was effective on diabetic complications (DM foot
ulcers), implying that skin stimulation (even by air) may
be an effective modality. This outcome may be insufficient
because it was reported only in one RCT (24).
One RCT of aromatherapy massage had 2 prominent
findings including decreased neuropathic pain and
improved quality of life. In this massage, Effleurage and
petrissage maneuvers were performed on hands and
feet with mixture oils like coconut, rosemary, geranium,
lavender, eucalyptus, and chamomile. The findings of the
AM may not be comprehensive due to the same reasons
that were previously mentioned for the CAM. Aromatic
oils may change the findings as well. In other words, the
lubricants or various oils used in massages can be absorbed
and alter the results (38,39,45-48).
Bayat and Asghari
Crescent Journal of Medical and Biological Sciences, Vol. 7, No. 1, January 2020 27
Compared to the systematic review of Ezzo et al, there
are more articles in our study that reported decreased FBS
and HbA1c with TM and SM (14). In addition, 2 other
articles showed the lowering effect of FBS (21) and HbA1c
(15) in T1DM by the SM. Diabetic neuropathy and foot
ulcer were improved and there was no report of massage
side effect.
It should be mentioned that there were other factors
which could affect the results, including the personality
of the masseur and the recipients, their communication
(49), the patient
s temperament, as well as the season,
and the time of receiving massage (5) although none of
the above-mentioned parameters were evaluated in the
present study. On the other hand, diabetes is caused by
various pathogens (50) that may differ in response to
massage. These modulators require further investigation
in the future.
There were some limitations in our systematic review
such as the low sample size of the RCTs, the undefined
pressure and velocity of strikes, undefined lubricants,
and ethnic differences. Finally, the outcome of massage
therapy depends on many variables that may alter the
findings. However, further study is recommended in this
regard.
Conclusions
Massage has received special attention as a non-drug,
safe, and feasible method of therapy from ancient times,
which can be a way to health although various message
methods have different effectiveness. Many modalities
can influence massage efficacy. An appropriate method
may have a major role in relieving the symptoms of DM
if it is matched with DM pathogenesis and the patient
s
condition. However, more studies are required to clarify
the efficacy of different types of massage on the DM.
Conflict of Interests
The authors declare that they have no conflicts of interest.
Ethical Issues
This study was a part of Dr. Bayat’s thesis with the ethical
code of IR.MUQ.REC.1395.147.
Financial Support
This study was supported by Qom University of Medical
Sciences, Qom, Iran.
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Aim: To investigate the effect of traditional massage on fasting blood glucose and sugar tolerance of patients with type 2 diabetes mellitus. Methods: Thirty-eight patients with type 2 diabetes mellitus were selected from the Outpatient Clinic of the Hospital Affiliated to the Medical College of Qingdao University between March 2000 and March 2003, and all enrolled subjects were in accordance with the diagnostic standard for diabetes carried out by the Ministry of Public Health as well as the diagnostic criteria of diabetes published by American Diabetes Association, including 19 males and 19 females with the average age of 45.6 years as well as an average course of disease of 2.6 years with the fasting plasma glucose ranged from 8.2 to 21.0 mmol/L, accompanied by the backache of different degree. The patients were randomly divided into treatment group and control group with 19 cases in each group. Patients with other serious diseases in organs or older than 70 years as well as those who were too weak to accept massage therapy were excluded. Patients in the treatment group orally took compound Jiangtangling for one week and then received traditional massage therapy for 30 days. Patients in the control group orally took Jiangtangling for 30 days three times a day with 1-2 tablets each time. The indexes were designed as follows by imitating Lu's report on lumbodorsal pain indexes according to the clinical symptoms: thirsty, debilitation, obesity or losing of body mass, backache, range of spinal motion as well as the fasting blood sugar, which were designed as 1:2:3:4:5. The fasting blood sugar, the blood sugar at 2 hours after meal and the insulin releasing were determined and statistically analyzed according to the standard statistical curative effect designed in 1997 on State Diabetes Meeting. Effective: Most of the symptoms disappeared after the treatment with the fasting blood glucose decreased to the normal level. Efficacy: The symptoms were significantly ameliorated after the treatment, and the fasting blood glucose decreased below 7.3 mmol. Improved: The symptoms were ameliorated much after the treatment than that before the treatment, and the fasting blood sugar decreased below 8.1 mmol. Invalid: There were no significant difference in the symptoms before and after the treatment, and the fasting blood sugar was about 8.1 mmol. Results: A total of 38 patients were involved in the analysis of results. 1 There were 13 patients with efficacy, 3 patients with validity, 2 patients being improved and one patient without efficacy in the treatment group after the treatment, and the efficient rate was 94.7%, while those in the control group were 1, 6, 4 and 8 respectively with the efficient rate of 42.1%. There were significant differences between the two groups (P < 0.01). 2 The insulin release in the treatment group was significantly different before and after the treatment [Average insulin release was (29.0±8.0), (26.0±8.0) IU/L, P < 0.01), and the indexes of sugar tolerances at each time point after the treatment were remarkably lower than those before the treatment [fasting blood sugar. (8.1 ±1.1),(5.6±1.1) mmol/L; the blood sugar at 2 hours after the meal: (9.8±1.1),(6.1±10.1) mmol/L, P all < 0.05, while those in the control group after the treatment were markedly lower than those before the treatment [fasting blood sugar: (8.2 ±1.2), (6.1±1.0) mmol/L;the blood sugar at 2 hours after the meal: (11.6±1.3),(8.5±1.2) mmol/L,P < 0.05). 3 The symptom index in the treatment group after the treatment was 57.0±0.0, while it was 83.7±0.0 in the control group, and there were significant differences between the two groups (P < 0.01). Conclusion: Traditional massage has great efficacy on type 2 diabetes mellitus, and its short-term efficacy is significantly superior to that of Jiangtangling.