New treatment for diabetes introduced at Guam conference

Spinal cord stimulation emerges as a promising option for diabetic neuropathy

Photo courtesy of medpagetoday.com

By Ron Rocky Coloma

When neurosurgeon Dr. Scott C. Dulebohn displayed an Oreo cookie during his presentation at the 26th Annual Guam Diabetes Conference on Sunday, the audience laughed. But the comparison was fitting. The small, round stimulator device he described–roughly the size of that cookie–could transform the lives of patients suffering from painful diabetic neuropathy.

Speaking at the Hilton Guam Resort & Spa, Dulebohn explained that spinal cord stimulation is now an FDA- and Medicare-approved treatment for patients whose diabetic nerve pain cannot be managed by medication alone. The device delivers mild electrical impulses to the spinal cord, disrupting pain signals before they reach the brain.

“It’s a completely reversible treatment,” he said. “We don’t cut anything. It’s done through the epidural space, and if you don’t like it, we can take it out.”

Traditional medications such as gabapentin, Lyrica or tricyclic antidepressants often fail to provide lasting relief. Dulebohn noted that about half of his patients stop taking their prescribed pain medications within three months.

“When medicines don’t work, we have to look at other options,” he said. “That’s where the spinal cord stimulator comes in.”

The therapy begins with a trial period, during which a temporary lead is inserted into the patient’s epidural space and connected to an external controller. If the patient experiences significant pain reduction—usually within three to seven days—they can then proceed with a permanent implant.

The stimulator’s battery, about half the thickness of an Oreo, is placed under the skin. It emits electrical pulses that interrupt pain messages, reducing the brain’s perception of discomfort.

“Electricity applied to the spine in certain patterns will stop the pain signal from being appreciated in the brain,” Dulebohn said.

In clinical trials, patients were 17 times more likely to achieve at least 50 percent pain relief with spinal cord stimulation compared to medication alone. Roughly 86 percent reported successful outcomes after one year, according to data cited by Dulebohn.

Dulebohn works with Medtronic, one of six U.S. companies approved to produce spinal cord stimulators. He said the devices used at Guam’s Medical City Center include a protective pouch that reduces infection risk “by 30 times.”

“The good news is this device is completely MRI compatible,” he said. “Even if a wire breaks, you can still safely get an MRI.”

The rechargeable battery can last up to nine years and can be charged wirelessly through the skin. “Unlike your phone that dies after two years, this will last,” Dulebohn said. “Even if you let it run out, you can recharge it again.”

He added that about 30 percent of patients report an improved quality of life, becoming more active and less dependent on pain medication. “If pain is better, you’re moving more. And when you’re moving more, your overall health improves,” he said.

While the treatment is approved primarily for painful diabetic peripheral neuropathy, it is also being used for phantom limb pain, post-surgical pain and other chronic nerve conditions.

Dulebohn emphasized that the stimulator does not interfere with the body’s natural healing. “We improve blood flow by getting people active again,” he said.

A full procedure costs around $20,000, though Dulebohn noted that Medicare and other insurance plans often cover it. “We’ve even been able to convince companies to provide the device free of charge in certain hardship cases,” he said.

Dr. Roy Raoul H. Felipe and Dr. Perie Adorable-Wagan addressed another serious complication: diabetic foot ulcers and peripheral artery disease. Both physicians emphasized prevention through regular foot checks, early wound care and improved blood circulation.

Felipe said that one out of every two Filipino patients with diabetic foot ulcers undergoes amputation, underscoring the importance of multidisciplinary wound care. “If we can save the limb, why not?” he said. “That’s quality of life for the patient.”

Adorable-Wagan added that peripheral artery disease—the narrowing

of arteries in the legs—is often overlooked but can be detected through simple, inexpensive tests such as the ankle-brachial index or 10-gram monofilament test. “PAD is a marker for systemic atherosclerosis,” she said. “Early detection means we can prevent ulcers, gangrene and amputations.”

Dr. Jonathon Thorp highlighted research showing that dietary changes and regular exercise can prevent, and in some cases reverse, diabetic neuropathy.

“Your genes are not your destiny,” Thorp said. “Your lifestyle is.”

Thorp explained that diabetic nerve damage is not only a nerve problem but also a vascular one, caused by impaired blood flow and oxidative stress. His prescription: a whole-food, plant-predominant diet, daily physical activity, seven to nine hours of sleep and social connection.

“The CHamoru diet a hundred years ago was plant-based,” he said. “We didn’t have diabetes then. We can return to that balance.”

Now in its 26th year, the Guam Diabetes Conference continues to serve as a hub for new research, technology and practical care strategies. With more than 30,000 residents living with diabetes and about 4,500 suffering from painful neuropathy, speakers urged both clinicians and patients to stay proactive.

“The people here make the difference,” Dulebohn said. “If we can help someone move again, reduce their pain and live better – that’s what makes it all worthwhile.”

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