Submitted to: Meeting Abstract
Publication Type: Abstract only
Publication Acceptance Date: 1/5/2005
Publication Date: 6/15/2005
Citation: Heptulla, R.A., Rodriguez, L.M., Bomgaars, L., Mason, K., Haymond, M.W. 2005. The role of subcutaneous pramlintide infusion in the treatment of adolescents with type 1 diabetes [abstract]. American Diabetes Association 65th Annual Meeting. Paper No. 447-P. Interpretive Summary:
Technical Abstract: Post-prandial hyperglycemia contributes significantly to the glycemic control in patients with type 1 diabetes (T1DM). Pramlintide, a synthetic analog of amylin markedly improves post-prandial hyperglycemia. In 2 randomized standard liquid meal (SLM) challenge visits, we studied 8 subjects with long-standing type 1 diabetes (T1DM) age 17+/-0.01 years and HbA1C 7.3+/-0.3%, on lispro insulin pump therapy and compared the effect of pramlintide when administered as either as a subcutaneous bolus injection (insulin: Pramlintide ratio [1 unit: 5 mcg]) or receiving the same dose as a square wave bolus along with usual insulin dose. Gastric emptying was assessed using 13C glucose in SLM and acetaminophen administration. Glucagon, pramlintide and insulin concentrations were assessed at baseline and post-prandially. Analysis of variance was used to analyze the data. There was no difference in insulin concentrations (p<0.99) during either of the studies; however, glucose concentrations were different (p<0.0001), with no immediate post-prandial hypoglycemia when subjects receiving pramlintide infusion as compared to bolus (AUC 0-180 min 450+/-152 vs 379+/-105 mg*min/dL). Glucagon suppression (p<0.001)and delay in gastric emptying measured by breath analysis of 13C (p<0.0003) and acetaminophen (p<0.01) concentrations were more pronounced when pramlintide was administered as a bolus as compared to infusion. We conclude that pramlintide infusion may offer an advantage over bolus subcutaneous injection in the treatment of postprandial hyperglycemia, and this therapeutic platform deserves further investigation.