# Long-Term Continuation of Outpatient Rehabilitation Improved Lower Limb Muscle Strength and Glycemic Control in a Frail Older Patient With Type 2 Diabetes Mellitus: A Case Report

## TL;DR

Long-term outpatient rehabilitation improved muscle strength and blood sugar control in a frail older person with type 2 diabetes over two years.

## Contribution

This case report demonstrates the benefits of long-term outpatient rehabilitation for frail older adults with type 2 diabetes.

## Key findings

- Knee extension force improved over two years of rehabilitation.
- The patient transitioned from frailty to robustness by month 9.
- Glycemic control improved in the second year after switching to continuous glucose monitoring.

## Abstract

Type 2 diabetes mellitus (T2DM) is associated with reduced lower limb muscle strength and is closely linked to physical frailty. Frail individuals often face difficulty in engaging in independent exercises, making outpatient rehabilitation (OR) under Japan’s long-term care insurance system a potentially effective intervention. Therefore, in this case, we provided long-term, continued exercise support through OR to an older, frail patient with T2DM. To ensure exercise adherence and prevent acute diabetic complications, we implemented a moderate- or lower-intensity exercise program consisting primarily of aerobic and resistance training, performed twice a week for 80 min per session, over 2 years. Consequently, the knee extension force improved over time. By month 9, the patient had transitioned from frailty to robustness according to the Japanese version of the Cardiovascular Health Study criteria. Regarding glycemic control, hemoglobin A1c (HbA1c) levels remained below baseline throughout the 2-year intervention. Although a temporary increase in HbA1c was observed at month 9, switching from self-monitoring of blood glucose to intermittently scanned continuous glucose monitoring enhanced the patient’s awareness of glycemic fluctuations. Consequently, HbA1c levels were lower in the second year than in the first year. These findings suggest that long-term OR may be beneficial for improving lower limb muscle strength, physical frailty, and glycemic control in older patients with T2DM.