title: Type 2 diabetes mellitus, etiology and possible treatment: preliminary report.
abstract: BACKGROUND
  Insulin resistance has been proposed as the initial step in the cascade toward type 2 diabetes mellitus. The mechanisms underlying the development of insulin resistance are not fully understood. We hypothesize that neurovascular interactions, in particular arterial elongation, causes compression of the right lateral medulla, triggering a state of autonomic dysfunction including hyperactivity of pancreatic endocrine function, and predisposes to insulin resistance and the development of type 2 diabetes.
  
  
  METHODS
  The clinical and operative findings were reviewed retrospectively in 15 patients with primary diagnoses of various right-sided cranial rhizopathies, but with a common diagnosis of type 2 diabetes mellitus. After microvascular decompression was performed for the primary diagnosis, arterial compression was observed of the lateral medulla and cranial nerve X and treated with microvascular decompression. Known duration of the diabetes ranged from "new" (patient was diagnosed as a result of preoperative blood work) to 16 years (mean 7.3 years). Duration of diabetes diagnosis was unknown in 2 patients. Follow-up was from 3 to 113 months (mean 29.9 months).
  
  
  RESULTS
  Ten of the 15 patients (66%) showed improvement in their blood glucose control; 5 of those 10 (50%) did so with no (4 patients) or less (1 patient) diabetes medication.
  
  
  CONCLUSIONS
  We have shown that arterial compression of the right lateral medulla is consistently present in patients with diabetes mellitus and that microvascular decompression can be performed safely. Further studies are necessary and are under way.
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Jannetta
authors.forename: Lynn
authors.initials: L
authors.lastname: Hollihan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D019299:Decompression, Surgical / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications / Q000601:surgery; D008297:Male; D008526:Medulla Oblongata / Q000098:blood supply / Q000503:physiopathology* / Q000601:surgery; D024821:Metabolic Syndrome / Q000209:etiology; D008875:Middle Aged; D010179:Pancreas / Q000503:physiopathology; D012189:Retrospective Studies