Surgical procedure may help control diabetes

A surgical procedure that reduces pressure on the blood vessels of a brain region that regulates the body’s vital functions appears, in some cases, to improve glucose control in patients with type-2 diabetes, a group of Pittsburgh physicians report.

Writing in the journal Surgical Neurology International>, a team of physicians report that by lifting and repositioning an artery that lay across the vagus nerve, they effected improvements in the metabolic function of seven of 10 patients. All 10 subjects in the trial had type-2 diabetes and exhibited visible nerve compression in a section of their medulla oblongata -- the brain region that sits at the top of the spinal cord and controls such basic functions as respiration and body temperature.

One subject was able to discontinue his diabetic medications entirely in the wake of the procedure, the group reported. The seven subjects who showed positive responses to the procedure had significant improvements in their glucose control as measured by changes in their hemoglobin A1c levels, fasting blood glucose and serum insulin levels.

The team, led by Dr. Peter Jannetta of Allegheny General Hospital in Pittsburgh, has pioneered the use of vascular decompression for conditions such as vertigo and facial pain and spasms. In earlier research, they had noted that 100% of a small group of diabetic patients on whom they operated for unrelated conditions had arterial compression of the vagus nerve in the anterolateral region of the medulla oblongata.

These findings point to a key role for the brain -- and the specific area in which Jannetta found and fixed arterial decompression -- in the development and progression of type-2 diabetes, and possibly in other metabolic syndromes, including hypertension.

Noting that the population of subjects in their study was small, the authors wrote, “we believe [this work] represents a major breakthrough in our understanding about the central nervous system etiology of the disease and the potential of surgical intervention as an alternative therapy for a significant subset of patients.

An accompanying editorial was a bit more muted. Dr. Sunil Patel and Joyce Nicholas, both of the Medical University of South Carolina, wrote that the observations presented in the study “are valuable starting points” to answering questions about what role arterial compression of nerves might play in diabetes and which patients might benefit from a surgical approach to treatment.

-- Melissa Healy / Los Angeles Times