Pramlintide: Clinical Strategies for Success

Diabetes is the most common of endocrine disorders, affecting almost 24 million people in the United States alone.1 The disease is chronic in nature and characterized by hyperglycemia, which can result in distressing daily symptoms that include fatigue, blurred vision, thirst, and frequent urination. Untreated hyperglycemia may lead to diabetic ketoacidosis and hyperosmolar hyperglycemic state, the two most serious acute metabolic complications of diabetes.2 Over time, if inadequately treated, chronic hyperglycemia can contribute to complications such as cardiovascular disease and stroke and can lead to retinopathy, neuropathy, and nephropathy. A primary goal of diabetes therapy is to attain and maintain optimal glucose control, which can reduce the risk of complications. Yet, despite the best of efforts, many people do not reach the recommended glycemic targets3 as outlined in Table 1.4 Pramlintide, an analog of the human hormone amylin, is an effective therapeutic approach that can assist patients in achieving optimal glucose goals. Amylin is a 37–amino acid peptide neuroendocrine hormone, which is co-secreted, along with insulin, by the pancreatic β-cells. Physiologically, amylin and insulin concentrations increase several-fold in response to nutrient intake. Together, insulin and amylin create a diurnal profile that can be described as synergistic. The ability of amylin to influence the appearance of meal-derived glucose in the bloodstream complements the mechanism by which insulin augments its disappearance, resulting in glucose regulation. View this table: Table 1. Summary of Glycemic Recommendations for Non-Pregnant Adults With Diabetes In the postprandial state, insulin works to remove glucose from the bloodstream by enhancing uptake in the skeletal muscle and adipose and peripheral tissue, as well as suppressing hepatic glucose production and the release of glucose from the liver. Amylin binds to specific receptors within the central nervous system to modulate appetite and food intake, regulate gastric emptying, and reduce production of glucagon …