Abstract
Pramlintide, a synthetic analog of amylin, improves postprandial hyperglycemia. We compared subcutaneous (s.c.) pramlintide injection with square wave pramlintide infusion in adolescents with type 1 diabetes (T1DM). Eight subjects with T1DM underwent two randomized studies. Subcutaneous pramlintide (dose = 5 μg/unit of insulin) bolus, was given one time and another time, the same dose was given as a 120-min s.c. infusion. Insulin dose was constant between studies. Gastric emptying was assessed with oral acetaminophen and [l-13C]glucose in meal. Plasma glucagon, pramlintide, and insulin concentrations were measured. Insulin concentrations (p < 0.99) between pramlintide injection versus infusion were similar; however, glucose concentrations were different (p < 0.0001), with the absence of hypoglycemia during pramlintide infusion [AUC (0–120 min) −0.07 ± 0.2 versus 1.05 ± 0.24 mg * h/dL (p < 0.0088)]. Insulin-only administration resulted in postprandial hyperglycemia and late postprandial hypoglycemia (p < 0.0001). Two subjects experienced hypoglycemia with pramlintide injection. Pramlintide bolus caused pronounced glucagon suppression (p < 0.0003) and delayed gastric emptying as ([13CO2] p < 0.0003 and acetaminophen p < 0.01) compared with infusion. We conclude that pramlintide bolus may result in an increase in risk of immediate postprandial hypoglycemia. Further modifications in pramlintide delivery are indicated before it can be safely used in children.
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Abbreviations
- HbA1c:
-
hemoglobin A1c
- T1DM:
-
type 1 diabetes
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Acknowledgements
The authors thank the GCRC nurses for the nursing assistance provided for this study. Drs. Orville Kolterman, David Maggs, and Mark Fineman were very helpful in providing the drug and pramlintide assay analysis (no monetary support was provided).
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This work is a publication of the USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX. The contents of this publication do not necessarily reflect the views of policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement from the U.S. government.
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Rodriguez, L., Mason, K., Haymond, M. et al. The Role of Prandial Pramlintide in the Treatment of Adolescents With Type 1 Diabetes. Pediatr Res 62, 746–749 (2007). https://doi.org/10.1203/PDR.0b013e318159af8c
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DOI: https://doi.org/10.1203/PDR.0b013e318159af8c
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