In Type 2 Diabetes Mellitus, normalization of hemoglobin A1c accompanies reduced sensitivity to pressure at the sternum

Abstract

BackgroundThe autonomic nervous system (ANS) maintains glucose homeostasis. While higher than normal glucose levels stimulate the ANS toward reduction, previous findings suggest an association between sensitivity to, or pain from, pressure at the chest bone (pressure or pain sensitivity, PPS) and activity of the ANS. A recent randomized controlled trial (RCT) of type 2 diabetes (T2DM) suggested that addition of an experimental, non-pharmacological intervention more effectively than conventional treatment lowered the levels of both PPS and HbA1c.Materials and analysesWe tested the null hypothesis that conventional treatment (n = 60) would reveal no association between baseline HbA1c and normalization of HbA1c in 6 months, related to change of PPS. We compared the changes of HbA1c in PPS reverters who experienced a minimum reduction of 15 units of PPS and in PPS non-reverters who experienced no reduction. Depending on the result, we tested the association in a second group of participants with addition of the experimental program (n = 52).ResultsIn the conventional group, PPS reverters experienced normalization of HbA1c that corrected the basal increase, thus disproving the null hypothesis. With the addition of the experimental program, PPS reverters experienced similar reduction. The reduction of HbA1c among reverters averaged 0.62 mmol/mol per mmol/mol increase of baseline HbA1c (P < 0.0001 compared to non-reverters). For baseline HbA1c ≥ 64 mmol/mol, reverters averaged 22% reduction of HbA1c (P < 0.01).ConclusionIn consecutive analyses of two different populations of individuals with T2DM, we demonstrated that the higher the baseline HbA1c, the greater the reduction of HbA1c but only in individuals with a concomitant reduction of sensitivity to PPS, suggesting a homeostatic effect of the autonomic nervous system on glucose metabolism. As such, ANS function, measured as PPS, is an objective measure of HbA1c homeostasis. This observation may be of great clinical importance.

New Diabetic Treatment by Alleviation of Autonomic Nervous System Dysfunction Measured as Periosteal Pressure Sensitivity at Sternum Improves Empowerment, Treatment Satisfaction, and Self-Reported Health of People with Type 2 Diabetes: A Randomized Trial

“… 9 The primary study demonstrated a decline of PPS that closely matched the decline of HbA1c, with elevated PPS closely associated with disruption of the central autonomic homeostatic regulation of blood glucose. 10 The disruption reverted when elevated PPS measures declined, in support of the notion of association between elevated sympathetic nerve activity, as matched by elevated PPS, and glucose regulation in T2D ( Figure 1 ). In continuation of these findings, a recent editorial suggests the PPS measure as an important measure for ANS function as well as a treatment target.…”

“…This is evident when examined alongside non-noxious withdrawal reflexes (eyeblink), resting heart rate (HR), heart rate variability upon standing, the baroreflex responsiveness (including blood pressure, HR and cardiac workload) to postural changes, and the autonomic homeostatic regulation of glucose metabolism. 9,10 This is confirmed in a recent review suggesting that the use of PPS is of clinical relevance as a measure for ANS activity and as a treatment target. 11 In people with cardiovascular disease, it has been found that lowering an elevated PPS, and thus potentially alleviating ANSD, can be obtained by bio-feedback-based self-measurement of PPS followed by a non-noxious cutaneous sensory nerve stimulation.…”

“…This is evident when examined alongside non-noxious withdrawal reflexes (eyeblink), resting heart rate (HR), heart rate variability upon standing, the baroreflex responsiveness (including blood pressure, HR and cardiac workload) to postural changes, and the autonomic homeostatic regulation of glucose metabolism. 9 , 10 This is confirmed in a recent review suggesting that the use of PPS is of clinical relevance as a measure for ANS activity and as a treatment target. 11 …”

“…21 If this condition persists, it may pass the ANS tipping point for internal regulation as shown in (A), which is associated with loss of autonomic homeostatic control of the sensitivity of the warning and defense system, measured as persistently elevated PPS. In addition, autonomic homeostatic control of glucose metabolism is also lost, 10,19 resulting in the development of type 2 diabetes. A vicious circle is established as ANSD itself is disease worsening.…”

In Ischemic Heart Disease, Reduced Sensitivity to Pressure at the Sternum Accompanies Lower Mortality after Five Years: Evidence from a Randomized Controlled Trial

“…Thus, in healthy individuals, measures of blood pressure, heart rate, work of the heart measured as the pressure rate product, plasma lipids, and glycated hemoglobin all declined in response to the intervention [33]. Also, in T2D, measures of glycated hemoglobin [34] and evidence of disturbed homeostatic regulation of glucose metabolism both declined in response to the intervention [35].…”