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Background  Autonomic nervous system dysfunction (ANSD) is known to affect glucose metabolism in the mammalian body. Tradition holds that glucose homeostasis is regulated by the peripheral nervous system, and contemporary therapeutic intervention reflects this convention.    Objectives  The present study tested the role of cerebral regulation of ANSD as consequence of novel understanding of glucose metabolism and treatment target in type 2 diabetes (T2D), suggested by the claim that the pressure pain sensitivity (PPS) of the chest bone periosteum may be a measure of cerebral ANSD.    Design  In a randomized controlled trial of 144 patients with T2D, we tested the claim that 6 months of this treatment would reduce PPS and improve peripheral glucose metabolism.    Results  In the active treatment group, mean glycated hemoglobin A1c (HbA1c) declined from 53.8 to 50.5 mmol/mol (intragroup  p  = 0.001), compared with the change from 53.8 to 53.4 mmol/mol in the control group, with the same level of diabetes treatment but not receiving the active treatment (between group  p  = 0.036). Mean PPS declined from 76.6 to 56.1 units ( p  < 0.001) in the active treatment group and from 77.5 to 72.8 units ( p  = 0.02; between group  p  < 0.001) in the control group. Changes of PPS and HbA1c were correlated ( r  = 0.37;  p  < 0.001).    Conclusion  We conclude that the proposed approach to treatment of T2D is a potential supplement to conventional therapy.    Clinical Trial Registration:   www.clinicaltrials.gov  (NCT 03576430).

Reduction of Pressure Pain Sensitivity as Novel Non-pharmacological Therapeutic Approach to Type 2 Diabetes: A Randomized Trial