November 14, 2020 : Issue #1080

TOP STORIES — Diabetes News and Research

The Benefits of Exenatide From the EXSCEL Study

Unique Shake Improves Glycemic Control in T2D

Early Metabolic Features In Relation to Type 2 Diabetes Susceptibility

When my wife first started using insulin, she had a pen she carried everywhere. She would test her glucose, log it on the phone, and then log her carbs, calculate her dose based on a laminated card, and inject her insulin. This process worked well but was very cumbersome.

She was able to get an early version of the InPen^TM and the iPhone app that went with it.

The InPen app made a big difference. She would test her glucose and the reading went into the app, and then she would count her carbs, enter into the app, and based on her ratios her dose would be calculated. The really cool feature was that the InPen app actually took into consideration her on-board insulin and adjusted her dose accordingly.

Once she injected the InPen sent a message to the app, so she always had a record of taking her dose. Now that Medtronic has the InPen you will be able to take advantage of their CGM to make insulin dosing more accurate and easier, and with the app you will be able to inject insulin whenever you need it.

This system opens up a new way for patients to have 24/7 control over their diabetes without needing a pump.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Medtronic, the global leader in medical technology, announced the launch of InPen™ integrated with real-time Guardian Connect™ CGM data. InPen is the first and only FDA-cleared smart insulin pen on the market for people on multiple daily injections (MDI). This integrated system now provides real-time glucose readings alongside insulin dose information, giving users everything they need to manage their diabetes in one view. Rather than switching between apps, users can see all their data in real-time, in one picture — making it easier to make smarter dosing decisions to manage their sugar levels. News Release

The EXSCEL trial may not have shown that once-weekly exenatide had cardiovascular benefits for patients with diabetes, but did show a benefit in some significant areas. 

A clinical pilot study reveals a new way to improve glycemic control by replacing daily breakfast and afternoon snacks with a diabetes-specific nutritional shake. 

The likelihood of developing type 2 diabetes can be detected at an early age. 

Scientists have found that insulin has met an evolutionary cul-de-sac, limiting its ability to adapt to obesity, thereby rendering most people vulnerable to type 2 diabetes.

A recent study from scientists at Indiana University School of Medicine, the University of Michigan, and Case Western Reserve University has determined that the sequence of insulin has become entrenched at the edge of impaired production, an intrinsic vulnerability unmasked by rare mutations in the insulin gene causing diabetes in childhood.

Insulin is produced by a series of highly specific processes in specialized cells, called beta cells. A critical step is the folding of a biosynthetic precursor, called proinsulin, to achieve the hormone’s functional three-dimensional structure. Past studies from this and other groups have suggested that impaired biosynthesis could result from diverse mutations that hinder proinsulin’s foldability.  This group sought to determine if the evolution of insulin in vertebrates—including humans—has encountered a roadblock.

The researchers looked at a subtle mutation in human insulin and other animals’ insulins, such as cows and porcupines. The mutant human insulin functions within the range of natural variation among animal insulins, yet this mutation has been excluded by evolution. The answer to this seeming paradox is that the forbidden mutation selectively blocks the folding of proinsulin and stresses beta cells. The group discovered that even the slightest variation of the insulin-sequencing process not only impairs insulin folding (and eventual insulin secretion) but also induces cellular stress that leads to beta-cell dysfunction and, eventually, permanent damage. The study highlights the importance of folding efficiency as a critical but hidden factor in insulin evolution over the past 540 million years. Humans have evolved to be vulnerable to diverse mutations in the insulin gene. This vulnerability underlies a rare monogenic form of diabetes and provides an evolutionary backdrop to the present obesity-related diabetes pandemic. National experts agree that this discovery offers critical insight to better understanding the development of type 2 diabetes in adults and children—which both are rising at alarming rates around the world.

Proceedings of the National Academy of Sciences PNAS Nov, 2nd 2020

Diabetes in Control gratefully acknowledges the assistance of the following pharmacy doctoral candidates in the preparation of this week’s newsletters:

Bernice Ford, 2021 PharmD Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences

Zahra Hashemy, PharmD. Candidate, USF Taneja College of Pharmacy

Aleksandra Kusic, PharmD Candidate, Florida A&M University, College of Pharmacy and Pharmaceutical Sciences

Destiny Reed, PharmD. Candidate, Florida A&M College of Pharmacy and Pharmaceutical Sciences

A‘Kira Shavers, PharmD Candidate, South College School of Pharmacy 

Alayna Marteal Wyre, Pharm. D. Candidate, South College School of Pharmacy 

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