K-ATP Channels and the Metabolic Regulation of Insulin Secretion in Health and Disease: The 2022 Banting Medal for Scientific Achievement Award Lecture

Diabetes is characterized by elevation of plasma glucose due to an insufficiency of the hormone insulin and is associated with both inadequate insulin secretion and impaired insulin action. The Banting Medal for Scientific Achievement Commemorates the work of Sir Frederick Banting, a member of the team that first used insulin to treat a patient with diabetes almost exactly one hundred years ago on 11 January 1922. This article is based on my Banting lecture of 2022 and concerns the mechanism of glucose-stimulated insulin secretion from pancreatic beta-cells, with an emphasis on the metabolic regulation of the K-ATP channel. This channel plays a central role in insulin release. Its closure in response to metabolically generated changes in the intracellular concentrations of ATP and MgADP stimulates beta-cell electrical activity and insulin granule exocytosis. Activating mutations in K-ATP channel genes that impair the ability of the channel to respond to ATP give rise to neonatal diabetes. Impaired K-ATP channel regulation may also play a role in type 2 diabetes. I conjecture that K-ATP channel closure in response to glucose is reduced because of impaired glucose metabolism, which fails to generate a sufficient increase in ATP. Consequently, glucose-stimulated beta-cell electrical activity is less. As ATP is also required for insulin granule exocytosis, both reduced exocytosis and less beta-cell electrical activity may contribute to the reduction in insulin secretion. I emphasize that what follows is not a definitive review of the topic but a personal account of the contribution of my team to the field that is based on my Banting lecture.

Automated summary

Diabetes is caused by insufficient insulin and involves both inadequate insulin secretion and impaired insulin action. This article is based on the Banting lecture in 2022 and focuses on the mechanism of glucose-stimulated insulin secretion and the role of the K-ATP channel. Activating mutations in K-ATP channel genes can lead to neonatal diabetes, and impaired K-ATP channel regulation may also contribute to type 2 diabetes.