Pramlintide Improved Glycemic Control and Reduced Weight in Patients With Type 2 Diabetes Using Basal Insulin

Riddle, Matthew C.; Frías, Juan P.; Zhang, Bei; Maier, Holly; Brown, Carl D.; Lutz, Karen; Kolterman, Orville G.

doi:10.2337/dc07-0589

Cited by 107 publications

(113 citation statements)

References 23 publications

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“…It is administered subcutaneously before meals and slows gastric emptying, inhibits glucagon production in a glucose-dependent fashion, and predominantly decreases postprandial glucose excursions [33]. In clinical studies, HbA 1c has been decreased by 0.5-0.7 percentage points [82]. The major clinical side effects of this drug are gastrointestinal in nature.…”

Section: Medicationsmentioning

confidence: 99%

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

et al. 2008

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The consensus algorithm for the medical management of type 2 diabetes was published in August 2006 with the expectation that it would be updated, based on the availability of new interventions and new evidence to establish their clinical role. The authors continue to endorse the principles used to develop the algorithm and its major features. We are sensitive to the risks of changing the algorithm cavalierly or too frequently, without compelling new information. An update to the consensus algorithm published in January 2008 specifically addressed safety issues surrounding the thiazolidinediones. In this revision, we focus on the new classes of medications that now have more clinical data and experience.

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Section: Medicationsmentioning

confidence: 99%

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

et al. 2008

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“…Our searches identifi ed 166 citations; of these, 7 randomized controlled trials (RCTs), [5][6][7][8][9][10][11] 3 companion articles, [12][13][14] and 4 pooled analyses [15][16][17][18] fulfi lled inclusion criteria. We also identifi ed 2 unpublished trials (study #137-117 and #137-123) from the FDA medical and statistical reviews.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Harms of the Hypoglycemic Agent Pramlintide in Diabetes Mellitus

Lee¹,

Norris

Thakurta³

2010

The Annals of Family Medicine

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PURPOSE We conducted a study to examine the effi cacy, effectiveness, and harms of pramlintide as adjunct therapy in adults and children with type 1 or type 2 diabetes. METHODSWe searched multiple bibliographic databases to January 2010, the US Food and Drug Administration Web site, and other sources to identify randomized controlled trials (RCTs) fulfi lling inclusion criteria. Syntheses were qualitative because data were too heterogeneous for meta-analysis. RESULTSThree published RCTs in type 1 diabetes and 4 in type 2 disease fulfi lled inclusion criteria. All trials were conducted with adults, and none was longer than 52 weeks. In type 1 diabetes with intensive insulin therapy, pramlintide was as effective as placebo in lowering glycated hemoglobin (HbA 1c ) levels in one trial. Pramlintide was somewhat more effective than placebo in patients using conventional insulin therapy, with a between-group difference in HbA 1c levels of 0.2% to 0.3% (2 studies). In patients with type 2 diabetes, pramlintide was more effective at reducing HbA 1c levels than placebo when added to fl exibly dosed glargine (without prandial insulin) and when added to fi xed-dose insulin therapies, with or without oral hypoglycemic agents (between-group differences in HbA 1c were approximately 0.4%). Weight loss was observed with pramlintide in both type 1 and type 2 diabetes, whereas placebo-treated patients tended to gain weight. Pramlintide-treated patients experienced more frequent nausea and severe hypoglycemia compared with patients treated with placebo.CONCLUSIONS Pramlintide was somewhat more effective than placebo as adjunct therapy for improving HbA 1c levels and weight in adults with type 1 diabetes on conventional insulin therapy, or type 2 diabetes and inadequate glycemic control with their current therapies, with between-group differences in HbA 1c levels in the range of 0.2% to 0.4%. Further research is needed to determine pramlintide's durability of hypoglycemic effect, as well as effects on patient-reported outcomes, morbidity, mortality, and long-term harms.

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“…A 16 week study of pramlintide vs placebo added to therapy in T2DM patients treated with basal insulin with or without oral agents showed that pramlintide resulted in a greater A1C reduction (−0.7 % vs −0.36 % on placebo) and significant weight loss (−1.6 kg vs +0.7 kg on placebo) [70]. In a 6 month study where T2DM patients with inadequate control on basal insulin with or without oral agents were randomized to the addition of mealtime insulin vs pramlintide, patients on pramlintide maintained weight while patients on mealtime insulin gained an average of +4.7 kg, with similar improvements in glycemic control in each group (−1.1 % and −1.3 % in the pramlintide and mealtime insulin groups, respectively) [71].…”

Section: Pramlintidementioning

confidence: 99%

Impact of Newer Medications for Type 2 Diabetes on Body Weight

Pedersen¹

2013

Curr Obes Rep

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Most patients with type 2 diabetes (T2DM) struggle with excess body weight. Many management strategies for achievement of euglycemia in T2DM are associated with weight gain, which worsens insulin resistance over time, increases health risk associated with obesity, and is associated with poor compliance with treatment. This review will discuss a host of new medications for management of hyperglycemia that have emerged and are emerging which are weight neutral, or facilitate weight loss. Incretin therapies are reviewed, including DPP-4 inhibitors which are weight neutral, and GLP-1 receptor agonists which can facilitate weight loss. SGLT-2 inhibitors, anticipated to become available soon, facilitate modest weight loss. Pramlintide can improve glycemic control and facilitate weight loss in T2DM patients on concomitant insulin therapy. The bile acid sequestering agent colesevelam, more recently approved for management of T2DM, modestly improves glycemic control and is weight neutral. The advent of these newer therapies makes it increasingly possible to optimize concomitant management of type 2 diabetes and obesity.

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Pramlintide Improved Glycemic Control and Reduced Weight in Patients With Type 2 Diabetes Using Basal Insulin

Cited by 107 publications

References 23 publications

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

Efficacy and Harms of the Hypoglycemic Agent Pramlintide in Diabetes Mellitus

Impact of Newer Medications for Type 2 Diabetes on Body Weight

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