Interactive diabetes case 16: A 61-year-old patient with uncontrolled type 2 diabetes on two oral agents – A4

ANSWER — Incorrect.

Pramlintide is a synthetic analogue of amylin.

Amylin is co-secreted with insulin from the beta cells of the pancreatic islets. Amylin molecules aggregate and form amyloid fibers. Amyloid deposits composed of amylin are present in beta cells (hence the name amylin) and may contribute to the pathogenesis of diabetes. Like insulin, secretion is deficient in patients with diabetes. Like glucagon-like peptide 1 (GLP-1) receptor agonists, amylin inhibits glucagon secretion, delays gastric emptying, and promotes satiety. However, it does not stimulate insulin secretion. (See "Amylin analogs for the treatment of diabetes mellitus", section on 'Pramlintide'.)

Pramlintide is a stable analogue of amylin with similar pharmacologic properties but without the potential for aggregation.

Pramlintide is approved for use in patients with type 1 and type 2 diabetes who are treated with insulin but are not meeting glycemic goals. Pramlintide cannot be mixed with insulin in the same syringe. Thus, the patient on pramlintide must inject pramlintide three times a day before each meal and also inject insulin separately.

Pramlintide may cause hypoglycemia, especially in patients with type 1 diabetes. It causes nausea in approximately 30 percent of patients, reduces the glycated hemoglobin (A1C) value by only 0.5 to 0.7 percent, and is expensive. It produces modest weight loss, due at least in part to the gastrointestinal (GI) side effects. It is contraindicated in patients with gastroparesis. There is limited long-term experience with this agent.

Pramlintide is not an appropriate therapy for the patient under consideration, because the patient is not taking insulin. It cannot be recommended, in general, for patients on insulin because of the considerations noted in the previous two paragraphs.

Return to the beginning to try again. (See "Interactive diabetes case 16: A 61-year-old patient with uncontrolled type 2 diabetes on two oral agents".)