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

¹ Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine, Oregon Health and Science University, Portland, Oregon
² Amylin Pharmaceuticals, San Diego, California

Address correspondence and reprint requests to Orville Kolterman, MD, Amylin Pharmaceuticals, 9360 Towne Centre Dr., San Diego, CA 92121. E-mail: orville.kolterman{at}amylin.com

OBJECTIVE— To assess the efficacy and safety of pramlintide in patients with type 2 diabetes suboptimally controlled with basal insulin.

RESEARCH DESIGN AND METHODS— In a 16-week, double-blind, placebo-controlled study, 212 patients using insulin glargine with or without oral antidiabetes agents (OAs) were randomized to addition of pramlintide (60 or 120 µg b.i.d./t.i.d.) or placebo. Insulin glargine was adjusted to target a fasting plasma glucose concentration of 70–100 mg/dl. One coprimary end point was the change in A1C at week 16. The other coprimary end point was a composite measure of overall diabetes control comprising A1C 7.0% or reduction 0.5%, mean daily postprandial glucose (PPG) increments 40 mg/dl, no increase in body weight, and no severe hypoglycemia. Patients meeting all four conditions at week 16 achieved this end point.

RESULTS—More pramlintide- than placebo-treated patients achieved the composite end point (25 vs. 7%; P < 0.001). Reductions (means ± SE) in A1C (–0.70 ± 0.11% vs. –0.36 ± 0.08%; P < 0.05) and PPG increments (–24.4 ± 3.6 mg/dl vs. –0.4 ± 3.0 mg/dl; P < 0.0001) were greater in pramlintide- versus placebo-treated patients, respectively. Glycemic improvements were accompanied by progressive weight loss with pramlintide and weight gain with placebo (–1.6 ± 0.3 kg vs. +0.7 ± 0.3 kg; P < 0.0001). No treatment-related severe hypoglycemia occurred.

CONCLUSIONS— Pramlintide improved multiple glycemic parameters and reduced weight with no increase in hypoglycemia in patients with type 2 diabetes who were not achieving glycemic targets with basal insulin with or without OAs.

Abbreviations: FPG, fasting plasma glucose • OA, oral antidiabetes agent • PPG, postprandial glucose

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