title: Pramlintide as an adjunct to insulin in patients with type 2 diabetes in a clinical practice setting reduced A1C, postprandial glucose excursions, and weight.
abstract: OBJECTIVE
  This study was designed to assess the safety and efficacy of pramlintide therapy in patients with type 2 diabetes in a clinical practice setting.
  
  
  METHODS
  In this open-label study, 166 insulin-treated patients with type 2 diabetes added pramlintide therapy (120 microg) during an initiation period in which mealtime insulin was reduced by 30-50%. Insulin doses were subsequently adjusted to optimize glycemic control. Endpoints included safety, as well as change in A1C, postprandial glucose, weight, insulin dose, and patient satisfaction following 6 months of pramlintide treatment.
  
  
  RESULTS
  At 6 months, the change in A1C from baseline (8.3%) was -0.56% (P < 0.05; n = 59). Pramlintide treatment significantly reduced mean postprandial glucose excursions (P < 0.05) and weight (-2.8 kg; P < 0.05; n = 125). Glycemic benefits were achieved with lower mealtime insulin doses (-10.3%; P < 0.05; n = 104). Nausea, primarily mild to moderate, was reported by 29.5% of patients (severe nausea in 2.4%). Rates of severe hypoglycemia were low (0.04 events/patient-year).
  
  
  CONCLUSIONS
  In this uncontrolled, open-label setting, pramlintide initiation while reducing mealtime insulin, followed by insulin dose optimization, resulted in improvements in postprandial glucose excursions and A1C. These improvements in glycemic control were accompanied by weight loss.
authors.affiliation: The Endocrine Clinic, Portland, Oregon, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Karl
authors.forename: Athena
authors.initials: A
authors.lastname: Philis-Tsimikas
authors.forename: Tamara
authors.initials: T
authors.lastname: Darsow
authors.forename: Gayle
authors.initials: G
authors.lastname: Lorenzi
authors.forename: Terrie
authors.initials: T
authors.lastname: Kellmeyer
authors.forename: Karen
authors.initials: K
authors.lastname: Lutz
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Juan P
authors.initials: JP
authors.lastname: Frias
mesh_terms: D000328:Adult; D000368:Aged; D000682:Amyloid / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D058228:Islet Amyloid Polypeptide; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D016896:Treatment Outcome
chemical_list: D000682:Amyloid; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D058228:Islet Amyloid Polypeptide; C105254:pramlintide