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Symlin modulates glucose homeostasis in type 1 diabetes
In patients with type 1 diabetes, the use of Symlin appears to be effective in regulating postprandial glucose homeostasis through its suppression of glucagon and delay of gastric emptying, according to recent findings.
Yogish C. Kudva, MBBS, professor of medicine, division of endocrinology and metabolism at Mayo College of Medicine in Rochester, Minnesota, and colleagues evaluated 12 patients with type 1 diabetes (mean age, 44.4 years) to determine the effect of the amylin analogue Symlin (pramlintide, AstraZeneca) on postprandial glucose fluxes in type 1 diabetes.
Patients were seen for two study visits, one of which included administration of subcutaneous pramlintide. During the other visit, patients administered their usual preprandial insulin bolus. Patients underwent a triple-tracer mixed-meal procedure and oral minimal model to determine postprandial glucose turnover and insulin sensitivity. A gastric emptying test was administered at baseline and within a week after the second study visit.
The researchers found that with pramlintide, there was an average 110.8-minute delay in peak postmeal glucose (P = .0001). Although this delay did not affect the total postprandial glucose fluctuation during a 360-minute period, it did have an effect on the 2-hour postprandial glucose fluctuations immediately after the meal (P = .0003). Researchers noted lower levels of plasma insulin with pramlintide during 120 minutes (P = .0099). At 120 minutes, postprandial fluctuations of glucagon also were decreased with pramlintide (P = .0147).
There was a decreased meal rate of glucose appearance at 120 minutes (P = .0316). However, the incremental area under the curve (iAUC) of meal rate of glucose appearance did not differ with or without pramlintide during the entire 0 to 360 minutes.
There was no difference in endogenous glucose production at 120 minutes or during the entire 360 minutes.
Although there was a lower rate of glucose disappearance during the early (0-120 minutes) postprandial period with pramlintide (P = .0083), the iAUC of rate of glucose disappearance did not differ with or without pramlintide during the entire 0 to 360 minutes.
No differences were seen in insulin sensitivity or liver insulin sensitivity with or without pramlintide.
“This study confirmed that suppressing postprandial glucagon concentrations and delaying gastric emptying using premeal pramlintide, decreased glucose excursions for the first 2 hours after a mixed meal,” the researchers wrote. – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.