title: Effect of Pramlintide on Postprandial Glucose Fluxes in Type 1 Diabetes.
abstract: Early postprandial hyperglycemia and delayed hypoglycemia remain major problems in current management of type 1 diabetes (T1D).
  
  
  
  Our objective was to investigate the effects of pramlintide, known to suppress glucagon and delay gastric emptying, on postprandial glucose fluxes in T1D.
  
  
  
  This was a single-center, inpatient, randomized, crossover study.
  
  
  
  Twelve patients with T1D who completed the study were analyzed.
  
  
  
  Subjects were studied on two occasions with or without pramlintide. Triple tracer mixed-meal method and oral minimal model were used to estimate postprandial glucose turnover and insulin sensitivity (SI). Integrated liver insulin sensitivity was calculated based on glucose turnover. Plasma glucagon and insulin were measured.
  
  
  
  Glucose turnover and SI were the main outcome measures.
  
  
  
  With pramlintide, 2-hour postprandial glucose, insulin, glucagon, glucose turnover, and SI indices showed: plasma glucose excursions were reduced (difference in incremental area under the curve [iAUC], 444.0 mMmin, P = .0003); plasma insulin concentrations were lower (difference in iAUC, 7642.0 pMmin; P = .0099); plasma glucagon excursions were lower (difference in iAUC, 1730.6 pg/mlmin; P = .0147); meal rate of glucose appearance was lower (difference in iAUC: 1196.2 μM/kg fat free mass [FFM]; P = .0316), endogenous glucose production was not different (difference in iAUC: -105.5 μM/kg FFM; P = .5842), rate of glucose disappearance was lower (difference in iAUC: 1494.2 μM/kg FFM; P = .0083). SI and liver insulin sensitivity were not different between study visits (P > .05).
  
  
  
  Inhibition of glucagon and gastric emptying delaying reduced 2-hour prandial glucose excursions in T1D by delaying meal rate of glucose appearance.
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Ling
authors.initials: L
authors.lastname: Hinshaw
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Michele
authors.initials: M
authors.lastname: Schiavon
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Vikash
authors.initials: V
authors.lastname: Dadlani
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Ashwini
authors.initials: A
authors.lastname: Mallad
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Chiara
authors.initials: C
authors.lastname: Dalla Man
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Adil
authors.initials: A
authors.lastname: Bharucha
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Rita
authors.initials: R
authors.lastname: Basu
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Geske
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Rickey E
authors.initials: RE
authors.lastname: Carter
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cobelli
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Ananda
authors.initials: A
authors.lastname: Basu
authors.affiliation: Division of Endocrinology and Metabolism (L.H., V.D., A.M., R.B., A.B., Y.C.K.), Mayo Clinic, Rochester, Minnesota; Department of Information Engineering (M.S., C.D.M., C.C.), University of Padova, Padova, Italy; Division of Gastroenterology (A.B.), Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research (J.R.G., R.E.C.), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Yogish C
authors.initials: YC
authors.lastname: Kudva
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007333:Insulin Resistance / Q000502:physiology*; D058228:Islet Amyloid Polypeptide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period / Q000187:drug effects*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D058228:Islet Amyloid Polypeptide; C105254:pramlintide