Pramlintide acetate in the treatment of Type 2 and Type 1 diabetes mellitus

Maintenance of glucose homeostasis involves the interplay of multiple glucoregulatory factors, including the pancreatic β-cell hormones insulin and amylin. Amylin, a neuroendocrine hormone, is secreted in response to nutrient intake and suppresses postprandial glucagon secretion, helps regulate gastric emptying, and reduces food intake. Patients with diabetes are deficient in both insulin and amylin - contributing to postprandial hyperglycemia. Pramlintide, an analogue of amylin, is the active ingredient in the SYMLIN^® (pramlintide acetate) injection. SYMLIN is indicated as an adjunctive treatment for insulin-using patients with diabetes and works through mechanisms similar to those of amylin. Clinical trials have demonstrated that pramlintide therapy improves postprandial glucose control, lowers A1C, and is accompanied by a reduction in body weight. Mild-to-moderate nausea and an increased risk of insulin-induced severe hypoglycemia have been the most common side effects. These side effects can be mitigated by gradual pramlintide dose escalation during treatment initiation and proactive mealtime insulin dose reduction upon initiation of pramlintide therapy.