Pramlintide: profile of an amylin analog

Amylin is a naturally occurring hormone that regulates food intake and postprandial glucose excursions. Amylin is synthesized in the β cell and cosecreted with insulin. Type 1 diabetes and insulin-requiring Type 2 diabetes are amylin-deficient as well as insulin-deficient states. Pramlintide is a synthetic amylin analog that is used for replacement therapy. Pramlintide therapy slows diabetes-mediated accelerated gastric emptying and restores meal-mediated suppression of glucagon secretion in patients with diabetes. Amylin receptors are primarily located in the CNS, which mediates all of its effects including decreases in food intake. In patients with diabetes, pramlintide treatment reduces hemoglobin A1C (HbA1c) 0.3-0.7% and decreases bodyweight. Side effects include nausea and hypoglycemia. Both can be minimized by an appropriate titration program. Recent pramlintide studies address improvements in delivery systems, use in pediatric and Type 2 diabetic populations, patient treatment satisfaction and new insights into its mechanisms of action.