Submitted to: Journal of Clinical Endocrinology and Metabolism
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/27/2009
Publication Date: 5/15/2009
Citation: Heptulla, R.A., Rodriguez, L.M., Mason, K.J., Haymond, M.W. 2009. Twenty-four-hour simultaneous subcutaneous basal-bolus administration of insulin and amylin in adolescents with type 1 diabetes decreases postprandial hyperglycemia. Journal of Clinical Endocrinology and Metabolism. 94(5):1608-1611. Interpretive Summary: Amylin is hormone secreted by pancreatic cells. In type 1 diabetes there is an insulin and amylin deficiency. Amylin helps to improve after-meal sugar levels. With just insulin treatment, after-meal blood sugar is high in diabetes patients. Hence, a study was undertaken to see if we can give continuous infusion of both hormones insulin and amylin to patients with type 1 diabetes. The reason for this study was to see if an infusion of insulin and amylin would improve after-meal blood sugars. We saw a 26% decrease in after meal blood sugars when amylin and insulin were given in pumps instead of just insulin alone. The infusion of these two hormones at the same time in separate pumps has the potential to improve after-meal blood sugars.
Technical Abstract: The purpose of this study was to examine the effect of continuous subcutaneous (sc) replacement of amylin and insulin for a 24-h period on glucose homeostasis in adolescents with type 1 diabetes. Thirteen adolescents with type 1 diabetes on insulin pump therapy participated in a randomized, controlled, crossover design study comparing continuous sc insulin monotherapy (part A) vs. continuous sc insulin and pramlintide infusion (part B). In part A, basal and bolus insulin infusion was per prescribed home regimen. In part B, the basal insulin infusion was the same as part A, but prandial insulin boluses were reduced by 20%. Basal and prandial bolus pramlintide were administered simultaneously via another pump. All boluses were given as a dual wave. The study regimen resulted in a 26% reduction in postprandial hyperglycemia as compared to insulin monotherapy (area under the curve, 600 min, 2610 +/- 539 vs. 692 +/- 861 mg/liter per min) (P < 0.008). Glucagon concentrations were suppressed postprandially (P < 0.003) but not in the postabsorptive state, whereas plasma insulin concentrations were unchanged. Simultaneous continuous sc pramlintide and insulin infusion has the potential of improving glucose concentrations by way of physiological replacement.