For decades, scientists have discovered an unusual pattern: persons living in high-altitude locations, where oxygen levels are lower than at sea level, develop diabetes at considerably lower rates. Now, researchers at the Gladstone Institutes in the United States claim to have discovered the scientific rationale for this "mountain effect"—and devised an experimental medication that could one day replicate it without the need to climb a peak. 

The new study, published in the journal Cell Metabolism, indicates that red blood cells, which are best known as the body's oxygen transport carriers, may operate as potent "glucose sinks" in low-oxygen environments. In layman's terms, a glucose sink is something that removes sugar from the bloodstream and uses it. That procedure decreases blood sugar levels, which is critical for diabetic management. 

"Red blood cells represent a hidden compartment of glucose metabolism that has not been appreciated until now," explained Isha Jain, PhD, the study's principal author. "This discovery could open up entirely new ways to think about controlling blood sugar." 

Low oxygen levels, often known as hypoxia, force the body to adapt. When Jain's team subjected mice to low-oxygen air similar to that encountered at high altitudes, they discovered that blood sugar levels plummeted dramatically after meals. Yolanda Martí-Mateos, PhD, observed that when mice were given sugar in hypoxia, it quickly disappeared from their bloodstream. "We looked at muscle, brain, liver—all the usual suspects—but nothing in these organs could explain what was happening." 

Further investigation indicated that red blood cells were absorbing the missing glucose. Under hypoxia, the body not only produces more red blood cells, but each cell also consumes more sugar than usual. The glucose contributed to the production of molecules that increase oxygen delivery to tissues, which is an important adaptation when oxygen is scarce. 

"What surprised me the most was the magnitude of the effect," explained Angelo D'Alessandro, PhD. "Red blood cells are typically assumed to be passive oxygen carriers. However, we discovered that they can account for a significant portion of total body glucose consumption, particularly during hypoxia." 

Building on this knowledge, the researchers evaluated HypoxyStat, an investigational medication. The pill works by increasing the binding strength of haemoglobin, a protein found in red blood cells that transports oxygen. This procedure mimics high-altitude circumstances within the body, causing red blood cells to absorb more glucose. In diabetic mice models, HypoxyStat reduced elevated blood sugar levels, allegedly exceeding some conventional treatments. 

"This is one of the first uses of HypoxyStat beyond mitochondrial disease," Jain informed the audience. "It provides a fresh perspective on diabetes treatment by utilising red blood cells as glucose sinks." 

Experts point out that the findings are now limited to animal studies, and human trials are required before therapeutic application. However, for countries such as India, which has one of the world's highest diabetes burdens, the ramifications are considerable. If subsequent studies demonstrate its safety and efficacy in humans, a "mountain in a pill" might represent a unique metabolic strategy — not by targeting insulin alone, but by leveraging the body's natural oxygen response mechanism. 

According to the researchers, the findings could have an impact on exercise science and trauma care, as oxygen shifts affect metabolism. Scientists see the discoveries as a promising first step toward understanding how the body adjusts to oxygen—and how that adaptation can be used to combat chronic diseases.