HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Levetan, C. Articles by Henry, R. R. Search for Related Content PubMed PubMed Citation Articles by Levetan, C. Articles by Henry, R. R. Social Bookmarking                What's this?

Impact of Pramlintide on Glucose Fluctuations and Postprandial Glucose, Glucagon, and Triglyceride Excursions Among Patients With Type 1 Diabetes Intensively Treated With Insulin Pumps

¹ Medstar Clinical Research Center, Washington, DC
² Amylin Pharmaceuticals, San Diego, California
³ Veterans Affairs, San Diego Healthcare System, University of California San Diego, California

OBJECTIVE—To assess the effects of adjunctive treatment with pramlintide, an analog of the ß-cell hormone amylin, on 24-h glucose fluctuations and postprandial glucose, glucagon, and triglyceride excursions in patients with type 1 diabetes intensively treated with continuous subcutaneous insulin infusion (CSII).

RESEARCH DESIGN AND METHODS—In this study, 18 patients (16 of whom could be evaluated) with type 1 diabetes (age 44 ± 11 years, HbA_1c 8.2 ± 1.3% [mean ± SD]) were given mealtime injections of 30 µg pramlintide t.i.d. for 4 weeks in addition to their preexisting CSII regimen (16 lispro, 2 regular insulin). Mealtime insulin boluses were reduced by a minimum of 10% during the first 3 days, and re-adjusted thereafter based on clinical judgment. At weeks 0 (baseline), 4 (on treatment), and 6 (2 weeks off treatment), 24-h interstitial glucose concentrations were measured using a continuous glucose monitoring system (CGMS), and postprandial plasma glucose, glucagon, and triglyceride concentrations were measured in response to a standardized test meal.

RESULTS—At baseline, patients had excessive 24-h glucose fluctuations, with 59% of the CGMS measurements >140 mg/dl, 13% <80 mg/dl, and only 28% in the euglycemic range (80–140 mg/dl). After 4 weeks on pramlintide, measurements in the hyperglycemic range declined to 48% and measurements within the euglycemic range increased to 37%. This shift from the hyperglycemic to the euglycemic range occurred with a concomitant 17% reduction in mealtime insulin dosages and without relevant increases in measurements below the euglycemic range (15%) or any severe hypoglycemic events. After 4 weeks on pramlintide, postprandial glucose, glucagon, and triglyceride excursions were reduced by 86, 87, and 72%, respectively (incremental areas under the curve, all P < 0.05 vs. baseline). At week 6 (off treatment), the 24-h glucose profile and postprandial glucose, glucagon, and triglyceride excursions approached pretreatment values.

CONCLUSIONS—In this study, the addition of pramlintide to insulin therapy reduced excessive 24-h glucose fluctuations as well as postprandial glucose, glucagon, and triglyceride excursions in patients with type 1 diabetes intensively treated with insulin pumps.

Abbreviations: AUC, area under the curve • CGMS, continuous glucose monitoring system • CSII, continuous subcutaneous insulin infusion • TSH, thyroid-stimulating hormone

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				R. Kahn, R. M. Robertson, R. Smith, and D. Eddy The Impact of Prevention on Reducing the Burden of Cardiovascular Disease Diabetes Care, August 1, 2008; 31(8): 1686 - 1696. [Abstract] [Full Text] [PDF]

				R. Kahn, R. M. Robertson, R. Smith, and D. Eddy The Impact of Prevention on Reducing the Burden of Cardiovascular Disease Circulation, July 29, 2008; 118(5): 576 - 585. [Abstract] [Full Text] [PDF]

				S. E. Inzucchi and D. K. McGuire New Drugs for the Treatment of Diabetes: Part II: Incretin-Based Therapy and Beyond Circulation, January 29, 2008; 117(4): 574 - 584. [Abstract] [Full Text] [PDF]

				T. A. Kellmeyer, N. C. Kesty, Y. Wang, J. P. Frias, and M. S. Fineman Pharmacokinetics of an Oral Drug (Acetaminophen) Administered at Various Times Relative to Subcutaneous Injection of Pramlintide in Subjects With Type 2 Diabetes J. Clin. Pharmacol., July 1, 2007; 47(7): 798 - 805. [Abstract] [Full Text] [PDF]

				B. P. Childs, N. C. Kesty, E. Klein, R. Rubin, and A. Wick Considering Pramlintide Therapy for Postprandial Blood Glucose Control Diabetes Spectr, April 1, 2007; 20(2): 108 - 114. [Abstract] [Full Text] [PDF]

				D. G. Marrero, J. Crean, B. Zhang, T. Kellmeyer, M. Gloster, K. Herrmann, R. Rubin, N. Fineberg, and O. Kolterman Effect of Adjunctive Pramlintide Treatment on Treatment Satisfaction in Patients With Type 1 Diabetes Diabetes Care, February 1, 2007; 30(2): 210 - 216. [Abstract] [Full Text] [PDF]

				S. V. Edelman and L. Caballero Amylin Replacement Therapy in Patients With Type 1 Diabetes The Diabetes Educator, May 1, 2006; 32(Supplement_3): 119S - 127S. [Abstract] [Full Text] [PDF]

				F. Santilli, G. Davi, A. Consoli, F. Cipollone, A. Mezzetti, A. Falco, T. Taraborelli, E. Devangelio, G. Ciabattoni, S. Basili, et al. Thromboxane-Dependent CD40 Ligand Release in Type 2 Diabetes Mellitus J. Am. Coll. Cardiol., January 17, 2006; 47(2): 391 - 397. [Abstract] [Full Text] [PDF]

				J. McQueen Pramlintide acetate Am. J. Health Syst. Pharm., November 15, 2005; 62(22): 2363 - 2372. [Abstract] [Full Text] [PDF]

				D. C. Klonoff Continuous Glucose Monitoring: Roadmap for 21st century diabetes therapy Diabetes Care, May 1, 2005; 28(5): 1231 - 1239. [Full Text] [PDF]

				A. Ceriello, L. Piconi, L. Quagliaro, Y. Wang, C. A. Schnabel, J. A. Ruggles, M. A. Gloster, D. G. Maggs, and C. Weyer Effects of Pramlintide on Postprandial Glucose Excursions and Measures of Oxidative Stress in Patients With Type 1 Diabetes Diabetes Care, March 1, 2005; 28(3): 632 - 637. [Abstract] [Full Text] [PDF]

				R. E. Glasgow, P. A. Nutting, D. K. King, C. C. Nelson, G. Cutter, B. Gaglio, A. K. Rahm, and H. Whitesides Randomized Effectiveness Trial of a Computer-Assisted Intervention to Improve Diabetes Care Diabetes Care, January 1, 2005; 28(1): 33 - 39. [Abstract] [Full Text] [PDF]

				O. Schmitz, B. Brock, and J. Rungby Amylin Agonists: A Novel Approach in the Treatment of Diabetes Diabetes, December 1, 2004; 53(suppl_3): S233 - S238. [Abstract] [Full Text] [PDF]

				C. Weyer, A. Gottlieb, D. D. Kim, K. Lutz, S. Schwartz, M. Gutierrez, Y. Wang, J. A. Ruggles, O. G. Kolterman, and D. G. Maggs Pramlintide Reduces Postprandial Glucose Excursions When Added to Regular Insulin or Insulin Lispro in Subjects With Type 1 Diabetes: A dose-timing study Diabetes Care, November 1, 2003; 26(11): 3074 - 3079. [Abstract] [Full Text] [PDF]

				E. L Kleppinger and E. M Vivian Pramlintide for the Treatment of Diabetes Mellitus Ann. Pharmacother., July 1, 2003; 37(7): 1082 - 1089. [Abstract] [Full Text] [PDF]