Brain surgery may help against diabetes

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A small study of 10 patients by Allegheny General Hospital physicians led by neurosurgeon Peter Jannetta suggests that a type of brain surgery can lead to significant improvement against the onset and progression of type 2 diabetes.

Type 2 diabetes is a chronic disease marked by high levels of glucose, or sugar, in the blood. Uncontrolled by medical intervention, it can lead to serious cardiovascular, vision and renal problems, amputations related to circulation problems, and even death.

The study about the effects of surgery to decompress an artery pressing on a section of the brain called the medulla oblongata was published today in the journal Surgical Neurology International. Lead author was Dr. Jannetta, who is known for his work developing the surgery, called microvascular decompression, which is used for such debilitating cranial nerve diseases as vertigo and spasmodic torticollis, a movement disorder. In the surgery, the compressive artery is repositioned and a protective pad is placed between it and the nerve.

The medulla oblongata is responsible for, among other things, function of the pancreas, which is involved in the production of insulin. Type 2 diabetes is characterized by a resistance to insulin, which helps the body effectively use glucose for energy.

Dr. Jannetta noted that an earlier group of his patients had both type 2 diabetes and what was considered unrelated cranial nerve disease. They were given the surgery to relieve arterial compression in the medulla oblongata. In enrolling type 2 diabetes patients for the latest study, he hypothesized that the nerve compression affected the pancreas and surgery could mitigate the disease.

The new study's 10 patients had both steadily progressive type 2 diabetes and medullary compression, which had been detected through MRI scans. They underwent microvascular decompression and were followed for a year, during which time they were not permitted to make any changes in diet, weight or activity.

Seven of the 10 showed significant improvement in their glucose control, demonstrated by measurement of diabetes markers and decreased medication dosages. One patient went off medication altogether.

The three who did not improve had higher body mass indexes, falling into the obese category. The other seven had BMIs in the overweight class.

A further, much larger study now is needed to corroborate the findings, Dr. Jannetta said in an AGH news release.

More details in tomorrow's Pittsburgh Post-Gazette.

Pohla Smith: psmith@post-gazette.com or 412-263-1228.


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