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Pramlintide addition improves on first-generation artificial pancreas systems
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ORLANDO, Fla. — Adults with type 1 diabetes experienced greater glycemic control with less variability when using an artificial pancreas system that administered a rapid-formulation insulin plus pramlintide vs. a system using rapid insulin alone, according to data presented here.
“There have been studies over the last 5 or 6 years consistently showing that if we deliver insulin in a closed-loop manner, we get better control than conventional pump therapy,” Ahmad Haidar, PhD, assistant professor in the department of biomedical engineering and associate member in the division of experimental medicine at McGill University in Montreal, said during a press briefing. “However, post-meal control remains a challenge. So, even with an insulin-alone artificial pancreas ... we still had difficulties controlling sugar levels following meals.”
In a pilot study that included 12 adults with type 1 diabetes, Haidar and colleagues assessed the effectiveness of adding the amylin analogue pramlintide (Symlin, AstraZeneca) to an artificial pancreas system. Participants used each of three artificial pancreas systems, in random order, for 24 hours: a system using regular insulin plus pramlintide, a system using rapid insulin plus pramlintide, and a system using rapid insulin alone. The dual-hormone systems required the users to wear two pumps, and the hormones were administered simultaneously in a fixed ratio, basal-bolus manner. For 2 weeks before the study, participants used pramlintide to optimize basal rates and carbohydrate ratios. During each inpatient 24-hour trial, participants ate the same three meals and a bedtime snack.
Rapid insulin plus pramlintide outperformed the other systems, although differences were not significant between the two pramlintide configurations. The percent of time spent in glucose range 3.9 mmol/L to 10 mmol/L was greatest for the system using rapid insulin plus pramlintide vs. rapid insulin alone (86% vs. 74%; P = .001). Mean glucose level was 7.4 mmol/L for the rapid insulin plus pramlintide system vs. 7.9 mmol/L for rapid insulin alone (P = .01). The coefficient of variance was 27% for the pramlintide plus rapid insulin system vs. 31% for rapid insulin alone (P = .017).
“We were expecting some benefits with the novel insulinpluspramlintide artificial pancreas but were surprised by the extent of improvements and the low rates of side effects,” Haidar told Endocrine Today. “Moreover, patients reported much higher satisfaction with pramlintide
than we expected.”
Haidar said a study of a triple-hormone artificial pancreas system using insulin, pramlintide and glucagon is planned to start in September. – by Jill Rollet
Reference:
Haidar A, et al. 210-OR. Presented at: American Diabetes Association 78th Scientific Sessions; June 22-26, 2018; Orlando, Fla.
Disclosures: Haidar reports he is a consultant to Eli Lilly and Company and receives research support from AgaMatrix and Medtronic Diabetes. Please see the abstract for all other authors’ relevant financial disclosures.