U.S. Pharm. 2019;44(10):1.

Late last month, scientists in Sweden published their discovery of a mechanism that regulates the release of insulin, a hormone that lowers blood-glucose levels. In type 2 diabetes, this mechanism is disrupted, and the researchers hope that their finding can lead to new treatments.

Worldwide, more than 400 million people suffer from type 2 diabetes, characterized by poor secretion of blood glucose–lowering insulin hormone from the pancreas. Impaired insulin secretion, it is widely known, is due to an inability of the insulin-containing secretory granules to attach themselves to and fuse with the cell membrane. Consequently, less insulin reaches the blood, and the body becomes less able to reduce blood-glucose levels.

In the Swedish study, the researchers identified a protein known as Sac2 that is found at lower levels in patients with type 2 diabetes. Reducing the levels of this protein by experimental means, the scientists explained, causes reduced insulin secretion from the beta-cells. By employing advanced microscopy measures, they were able to demonstrate that Sac2 is an important component on the surface of the insulin-containing secretory granules, where it modifies the membrane’s fat composition. Without Sac2, the researchers found, a specific fat molecule accumulates on the surface of the secretory granules, incapacitating them so that they cannot dock to the cell membrane. This in turn reduces insulin secretion.

Notably, the clinical study shows that reduced levels of a specific protein results in beta-cells that exhibit several defects associated with type 2 diabetes. It also shows, the researchers point out, that the fat composition of the insulin-containing secretory granules is important owing to their ability to be released from the cells. The scientists now hope that it will be possible to use these findings to develop new ways of treating type 2 diabetes.

In other diabetes news, on September 20, the FDA approved oral semaglutide tablets to lower blood glucose in adults with type 2 diabetes. The first glucagon-like peptide-1 analogue in pill form provides an alternative for patients disinclined to SC inject semaglutide. Learn about this important treatment option in this month’s CE article coauthored by Contributing Editor Joshua J. Neumiller, PharmD, CDE, FAADE (page 36).

Also, an article by Christina M. Bookwalter, PharmD, BCPA, examines the growth of self-monitoring of blood glucose since the American Diabetes Association established guidelines in 1987 (page 29). Thanks to a number of inventive products and techniques, patients today have more options at their disposal than ever before. In addition, this issue’s Senior Care column (page 4) by Mary Ann Zagaria, PharmD, MS, BCGP, describes how pharmacists can help ensure that older patients do not trigger hypoglycemia when taking other drugs with their diabetes medications. Finally, this month’s Patient Teaching Aid (page 13) guides pharmacists on how to counsel patients about hypoglycemia and what to do when it occurs.

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