Insulin Resistance, Muscle Protein Metabolism, and Physiotherapy Outcomes in Type 2 Diabetes Mellitus: A Narrative Review

Type 2 diabetes mellitus is associated with impaired muscle function and may alter the response of skeletal muscle to nutrition and resistance exercise.This narrative review examines the proposed links between insulin resistance, disrupted anabolic signaling, inflammation, oxidative stress, and muscle protein metabolism, and considers their potential implications for physiotherapy.Evidence from mechanistic and clinical studies suggests that metabolic health may influence gains in muscle mass, strength, and physical function during rehabilitation.However, whether insulin resistance independently determines the response to resistance training remains uncertain, and mechanistic findings do not establish that targeting these pathways improves clinical rehabilitation outcomes.Resistance exercise remains an important component of care for people with type 2 diabetes.Rehabilitation plans should account for individual functional capacity, nutritional status, glycemic management, and treatment goals.Further studies directly comparing rehabilitation responses and measuring both biochemical and functional outcomes are needed to establish whether specific adjustments to exercise or nutritional prescriptions improve results.