OPTIMIZATION OF A SYSTEMIC APPROACH TO REHABILITATION OF PATIENTS WITH DIABETES MELLITUS AND HIGH COMORBIDITY IN HOT CLIMATIC CONDITIONS

High comorbidity in type 2 diabetes mellitus (T2DM) under hot climate conditions creates additional risks of decompensation and heat-related injuries. Traditional rehabilitation programs do not adequately consider climatogeographic factors. The study included 186 patients with T2DM, arterial hypertension, and obesity (Charlson comorbidity index ≥4) permanently residing in a tropical climate region (mean annual temperature +28°C, humidity >70%). A 16-week optimized rehabilitation program was developed and tested, including an acclimatization phase, fluid intake correction, individualized thermomonitoring (body temperature, heat stress index), adapted aerobic training in early morning hours, and an educational module. In the main group (n=93), a reduction in mean HbA1c by 1.1% (p<0.01), a 58% decrease in hypoglycemia episodes, a 12.4 mmHg reduction in systolic blood pressure (p<0.01), improved thermoregulation (a 0.8°C reduction in rectal temperature rise during exercise), and a 34% improvement in quality of life according to the SF-36 questionnaire (p<0.01) were achieved. An algorithm for systemic rehabilitation considering the thermal factor is proposed.

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