Results of the trial showed that seven of the ten patients who underwent MVD experienced significant improvement in their glucose control, based on measurement of diabetes markers (changes in hemoglobin A1c, fasting blood glucose and serum insulin levels) and decrease of diabetes medication dosages.   One patient was able to discontinue his diabetic medications entirely.

Dr. Jannetta said body mass index also appeared to be an important factor in who responded well to surgery.  Those in the study who had the best outcome from MVD had BMIs classified as overweight while those who did not respond had BMIs in the obese category.    

"Diabetes is a tremendously difficult condition to manage and, for patients, to live with.  Though our study involves a relatively small sampling of patients, we believe that it 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.  The next step is a much larger prospective clinical investigation to further corroborate what we have found," Dr. Jannetta said.

Commenting on the study in an accompanying editorial, Sunil Patel, MD, Chair of the Department of Neurosciences at the Medical University of South Carolina and Joyce Nicholas, Ph.D., Associate Professor in MUSC's Department of Biostatistics and Epidemiology, concur on the importance of the AGH team's work and the need for continued investigation:

"These observations point the way to further questions that need to be answered to conclude definitively that pulsatile arterial compression of the right anterolateral medulla is an independent risk factor for type 2 diabetes mellitus.  Like Dr. Jannetta's earlier observations on essential hypertension, the observations presented [in the current study] are valuable starting points for questions related to the exact location of arterial compression relevant to type 2 diabetes mellitus, the best experimental measure of response, and the subset of patients most likely to benefit from microvascular decompression surgery.  We encourage their continued efforts and those of other researchers in addressing the questions raised by this valuable contribution to our understanding of the disease and its treatment."

SOURCE Allegheny General Hospital