Levetan, Claresa;
Want, Laura L.;
Weyer, Christian;
Strobel, Susan A.;
Crean, John;
Wang, Yan;
Maggs, David G.;
Kolterman, Orville G.;
Chandran, Manju;
Mudaliar, Sunder R.;
Henry, Robert R.
Impact of Pramlintide on Glucose Fluctuations and Postprandial Glucose, Glucagon, and Triglyceride Excursions Among Patients With Type 1 Diabetes Intensively Treated With Insulin Pumps
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Medientyp:
E-Artikel
Titel:
Impact of Pramlintide on Glucose Fluctuations and Postprandial Glucose, Glucagon, and Triglyceride Excursions Among Patients With Type 1 Diabetes Intensively Treated With Insulin Pumps
Beteiligte:
Levetan, Claresa;
Want, Laura L.;
Weyer, Christian;
Strobel, Susan A.;
Crean, John;
Wang, Yan;
Maggs, David G.;
Kolterman, Orville G.;
Chandran, Manju;
Mudaliar, Sunder R.;
Henry, Robert R.
Beschreibung:
<jats:p>OBJECTIVE—To assess the effects of adjunctive treatment with pramlintide, an analog of the β-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).</jats:p>
<jats:p>RESEARCH DESIGN AND METHODS—In this study, 18 patients (16 of whom could be evaluated) with type 1 diabetes (age 44 ± 11 years, HbA1c 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.</jats:p>
<jats:p>RESULTS—At baseline, patients had excessive 24-h glucose fluctuations, with 59% of the CGMS measurements &gt;140 mg/dl, 13% &lt;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 &lt; 0.05 vs. baseline). At week 6 (off treatment), the 24-h glucose profile and postprandial glucose, glucagon, and triglyceride excursions approached pretreatment values.</jats:p>
<jats:p>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.</jats:p>