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 Table of Contents  
LETTER TO THE EDITOR
Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 379-380

Percutaneous electric neurostimulation of dermatome T7 as a potential adjunct therapy for decreasing insulin resistance and improving glycemic control in patients with type 2 diabetes


Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, Italy

Date of Submission20-Nov-2020
Date of Decision13-Jan-2021
Date of Acceptance23-Jun-2021
Date of Web Publication30-Sep-2021

Correspondence Address:
Dr. Chidiebere Emmanuel Okechukwu
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome.
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOD.JOD_98_20

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How to cite this article:
Okechukwu CE. Percutaneous electric neurostimulation of dermatome T7 as a potential adjunct therapy for decreasing insulin resistance and improving glycemic control in patients with type 2 diabetes. J Diabetol 2021;12:379-80

How to cite this URL:
Okechukwu CE. Percutaneous electric neurostimulation of dermatome T7 as a potential adjunct therapy for decreasing insulin resistance and improving glycemic control in patients with type 2 diabetes. J Diabetol [serial online] 2021 [cited 2021 Nov 30];12:379-80. Available from: https://www.journalofdiabetology.org/text.asp?2021/12/3/379/327321



Dear editor,

Type 2 diabetes mellitus (T2DM) has been associated with autonomic nervous system dysfunction, and the neural regulation of metabolic activities could serve as a therapeutic pathway for the treatment of T2DM using neuromodulation.[1] Electrical stimulation of the dorsal motor nucleus of the vagus or the nucleus of the tractus solitarius innervating the pancreas increases insulin secretion.[2] Moreover, vagal stimulation of the pancreatic gland through an implantable gastric electrical stimulator increases parasympathetic activity and reduces sympathetic neural activity; this increases insulin secretion concomitant with reduction in circulating glucose level.[3] The inhibition of the sympathetic neural activity via parasympathetic stimulation of the pancreas using percutaneous electric neurostimulation (PENS) of dermatome T7, which involves the use of needles with electrical stimulus at an alternating frequency of 15 and 30 Hz, may lead to decrease in insulin resistance; this demonstrates the impact of neuromodulation on homeostasis of blood glucose level.[4] During PENS of dermatome T7 therapy, the reflex of dermatome T6 is partially activated; this causes a delay in gastric emptying due to the inhibition of ghrelin released by the gastric fundus.[3] The inhibition of ghrelin has been shown to increase pancreatic secretion of insulin and reduce resistance to its peripheral action, especially in the adipose tissue.[5],[6]

Catalogna et al.[7] observed that a non-invasive PENS treatment of very short duration is sufficient to increase glucose utilization and improve hepatic insulin sensitivity in rats. The application of PENS therapy even for a very short period can improve glycemic control, perhaps by reducing hepatic glucose production which may be mediated via hypothalamic-pituitary-adrenal axis modulation.[6] Abdel-Kadar[8] observed that PENS of dermatome T6 was associated with a decrease in appetite, and when combined with a weight loss diet, it caused a significant weight reduction compared with diet alone in morbidly obese patients. Ruiz-Tovar et al.[4] found that PENS of dermatome T7 in combination with dietary therapy of 1200 kcal/day resulted in a substantial reduction in glycemia and insulin resistance than with only diet after 3 months of treatment.

In conclusion, intermittent PENS of dermatome T7 therapy could restore dysfunctional neurometabolic circuitry of the pancreas and may turn out to be a novel therapeutic prospect for decreasing insulin resistance and improving glycemic control in patients with T2DM. PENS of dermatome T7 mechanism of action may be associated with the generation of a somato-autonomic reflex, with sensory nerve endings of dermatome T7 as afferent pathway and the vagal branches as efferent pathway which will eventually stimulate the pancreas. However, there is need to substantiate the effectiveness of PENS of dermatome T7 in reducing insulin resistance and improving glycemic control in patients with T2DM by conducting further experimental research and clinical trials, including standardizing the precautionary and safety measures that should be observed while carrying out this procedure. However, significant improvements in PENS therapy may be achieved through an extensive understanding of the targeted nerve pathways and their physiological and pathophysiological roles, especially the sympathetic and parasympathetic pathways innervating the pancreas; such knowledge will enhance PENS protocols. Moreover, conducting a clinical trial that incorporates PENS, dietary, and exercise regimen for decreasing insulin resistance and improving glycemic control in patients with T2DM could yield more positive outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Seicol BJ, Bejarano S, Behnke N, Guo L. Neuromodulation of metabolic functions: From pharmaceuticals to bioelectronics to biocircuits. J Biol Eng 2019;13:67.  Back to cited text no. 1
    
2.
Ionescu E, Rohner-Jeanrenaud F, Berthoud HR, Jeanrenaud B. Increases in plasma insulin levels in response to electrical stimulation of the dorsal motor nucleus of the vagus nerve. Endocrinology 1983;112:904-10.  Back to cited text no. 2
    
3.
Chen J. Mechanisms of action of the implantable gastric stimulator for obesity. Obes Surg2004;14(Suppl 1):S28-S32.  Back to cited text no. 3
    
4.
Ruiz-Tovar J, Llavero C, Ortega I, Diez M, Zubiaga L, Calpena R. Percutaneous electric neurostimulation of dermatome T7 improves glycemic profile in obese and type 2 diabetic patients. A randomized clinical study. Cir Esp 2015;93:460-5.  Back to cited text no. 4
    
5.
Dezaki K. Ghrelin function in insulin release and glucose metabolism. Endocr Dev 2013;25:135-43.  Back to cited text no. 5
    
6.
Catalogna M, Fishman S, Halpern Z, Ben-Shlomo S, Nevo U, Ben-Jacob E. Regulation of glucose dynamics by noninvasive peripheral electrical stimulation in normal and insulin-resistant rats. Metabolism 2016;65:863-73.  Back to cited text no. 6
    
7.
Catalogna M, Doenyas-Barak K, Sagi R, Abu-Hamad R, Nevo U, Ben-Jacob E, et al. Effect of peripheral electrical stimulation (PES) on nocturnal blood glucose in type 2 diabetes: A randomized crossover pilot study. PLoS One 2016;11:e0168805.  Back to cited text no. 7
    
8.
Abdel-Kadar M. Percutaneous electrical neurostimulation (PENS) of dermatome T6 with an ambulatory self-applied patch vs PENS of dermatome T6 with conventional procedure: Effect on appetite and weight loss in moderately obese patients. Obes Surg 2016;26:2899-905.  Back to cited text no. 8
    




 

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