Twenty-four-hour simultaneous subcutaneous Basal-bolus administration of insulin and amylin in adolescents with type 1 diabetes decreases postprandial hyperglycemia

Abstract

Context: The purpose of this study was to examine the effect of continuous sc replacement of amylin and insulin for a 24-h period on glucose homeostasis in adolescents with type 1diabetes.

Methods: Thirteen adolescents with type 1 diabetes on insulin pump therapy participated in a randomized, controlled, crossover design study comparing continuous sc insulin monotherapy (part A) vs. continuous sc insulin and pramlintide infusion (part B). In part A, basal and bolus insulin infusion was per prescribed home regimen. In part B, the basal insulin infusion was the same as part A, but prandial insulin boluses were reduced by 20%. Basal and prandial bolus pramlintide were administered simultaneously via another pump. All boluses were given as a dual wave.

Results: The study regimen resulted in a 26% reduction in postprandial hyperglycemia as compared to insulin monotherapy (area under the curve, 600 min, 2610 +/- 539 vs. 692 +/- 861 mg/liter . min) (P < 0.008). Glucagon concentrations were suppressed postprandially (P < 0.003) but not in the postabsorptive state, whereas plasma insulin concentrations were unchanged.

Conclusions: Simultaneous continuous sc pramlintide and insulin infusion has the potential of improving glucose concentrations by way of physiological replacement.

Trial registration: ClinicalTrials.gov NCT00291772.

Figures

Figure 1

Top panel, Schematic representation of insulin and pramlintide delivery as a 70–30 dual wave bolus. Part A insulin is shown as a dotted line, and part B pramlintide and insulin are shown as solid lines. Blood glucose change from baseline is shown from 0700 to 1700 h. The graphs include two meals: breakfast is a liquid meal, and lunch is a solid meal. Middle panel displays corresponding glucagon concentrations, and lower panel shows insulin concentrations between the two studies. Closed circles represent part A, (insulin only) and open circles represent part B, (insulin and Pramlintide). Data are expressed as mean and sem.