Effect of Pramlintide on Prandial Glycemic Excursions During Closed-Loop Control in Adolescents and Young Adults With Type 1 Diabetes
Diabetes Care, 07/27/2012
Weinzimer SA et al. – Pramlintide delayed the time to peak postprandial blood glucose (BG) and reduced the magnitude of prandial BG excursions. Beneficial effects of pramlintide on closed–loop (CL) may in part be related to higher premeal insulin levels at lunch and dinner compared with breakfast.Methods
- Eight subjects (4 female; age, 15–28 years; A1C, 7.5 ± 0.7%) were studied for 48 h on a CL insulin-delivery system with a proportional integral derivative algorithm with insulin feedback: 24 h on CL control alone (CL) and 24 h on CL control plus 30-μg premeal injections of pramlintide (CLP).
- Target glucose was set at 120 mg/dL; timing and contents of meals were identical on both study days.
- No premeal manual boluses were given.
- Differences in reference BG excursions, defined as the incremental glucose rise from premeal to peak, were compared between conditions for each meal.
- CLP was associated with overall delayed time to peak BG (2.5 ± 0.9 vs. 1.5 ± 0.5 h; P < 0.0001) and reduced magnitude of glycemic excursion (88 ± 42 vs. 113 ± 32 mg/dL; P = 0.006) compared with CL alone.
- Pramlintide effects on glycemic excursions were particularly evident at lunch and dinner, in association with higher premeal insulin concentrations at those mealtimes.