19:32 EST, 31 March 2014
|
19:32 EST, 31 March 2014
Doctors are using a tiny wire to burn nerves to the kidneys
Hot-wiring
the kidneys may be a new way to tackle type 2 diabetes. Doctors are
using a tiny wire to burn nerves to the kidneys that they believe will
improve the way sugar is processed by the body.
People with type 2
diabetes either don’t produce enough insulin – the hormone that mops up
sugar from the blood – or their body’s cells don’t react to insulin
properly. As a result, their blood sugar levels rise.
The new
procedure involves destroying part of the sympathetic nervous system,
which runs from the spinal cord to the organs and is involved in the
fight-or-flight response – when danger threatens, it makes the heart
beat faster, for example. It also has a key role in regulating blood
pressure.
People with high blood pressure that does not respond to
medication have been shown to have higher levels of sympathetic nervous
system activity than normal. One theory is that this is because of
faulty signals travelling between the brain and kidneys along the renal
nerves. Destroying these nerves – a procedure known as renal denervation
– is being used to treat patients with this condition.
But a pilot study also showed that the procedure not only lowered blood pressure, but improved the effectiveness of insulin.
It
is recognised that the sympathetic nervous system affects the use of
insulin by the body. Blocking the sympathetic nervous system with a drug
called moxonidine has been shown to improve the action of insulin and
increase the amount of glucose taken in by cells.
Now, in a trial at
the University of Monash in Australia, renal denervation is being tested
to see if it has the same effect. During the 40-minute procedure,
carried out without a general anaesthetic, a catheter or tube is
inserted into the main artery in the groin and pushed up to the kidneys.
Once
in place, a radio-frequency generator, which creates heat and energy,
warms up a wire inside the catheter. This hot wire is placed against the
renal nerves and the heat destroys them.
In the new trial,
researchers will test the procedure on a group of 20 patients with type 2
diabetes. Half will have the treatment and the remainder will get
normal care and act as a control group.
Stella Vig, consultant
vascular and general surgeon and chair of the London Diabetic Foot
Network, said: ‘This is an exciting concept that may allow patients more
independence from the diabetic medication controlling their condition.
‘This
technique may allow diabetes to be managed with no additional
medication or a major reduction in the amount being taken. The cost of a
lifetime supply of diabetic medication is high and a one-off
intervention that allows diabetic control is therefore an important
concept for the cash-strapped NHS.’
 Meanwhile, a back and foot tickler is being used to tackle a common and painful side-effect of diabetes.
The
implanted device is being used to tackle nerve damage caused by high
blood sugar levels, which affects 60 to 70 per cent of people with type 1
or 2 diabetes.
‘This is an exciting concept that may allow patients more independence from the diabetic medication’
Symptoms can include numbness and tingling in the feet and hands; a burning, stabbing or shooting pain; and muscle weakness.
In
a trial at Maastricht University Hospital, in the Netherlands,
researchers are using a type of spinal stimulation for those with
moderate to severe nerve damage in the lower limbs and feet.
The
system includes a matchbox-sized control pad, which is implanted under
the skin of the abdomen or the side of the chest. A subcutaneous lead
connects this to an electrode implanted next to the spinal cord into
which it sends tiny electrical currents.
It is thought this can change the way pain signals are processed by the brain, so acute pain can be replaced by mild tingling.
Researchers
are testing the device on 40 patients and believe it will more than
halve pain levels, as well as improve quality of life and sleep.
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