Diabetes Care：普兰林肽改善对I型糖尿病患者的血糖控制

普兰林肽(pramlintide)是胰岛β细胞自然产生的胰淀素(amylin)的类似物。根据一篇于2012年6月18日在线发表在Diabetes Care期刊上的论文，在餐前，注射普兰林肽改善通过闭环人工胰岛系统(closed-loop artificial pancreas system)接受胰岛素治疗的I型糖尿病患者体内的血糖控制。

为了研究餐前注射普兰林肽是否通过延缓胃排空(gastric emptying)来改善餐后血糖症，来自美国耶鲁大学医学院的Stuart A. Weinzimer博士和同事们利用一种闭环胰岛素运送系统在24小时内单独或再加上餐前注射30 µg普兰林肽来治疗8名I型糖尿病(15到30岁)。

研究人员发现注射普兰林肽显著性地增加血糖到达峰值的平均时间(从1.5小时提高至2.5小时)。当餐前胰岛素浓度比较高时，注射普兰林肽也显著性地降低血糖波动的平均强度(从113 mg/dL降至88 mg/dL)，而且这种降低在午餐和晚餐时特别显著。

本文编译自Pramlintide improves glucose control in type 1 diabetes

doi: 10.2337/dc12-0330
PMC:
PMID:

Effect of Pramlintide on Prandial Glycemic Excursions During Closed-Loop Control in Adolescents and Young Adults With Type 1 Diabetes

STUART P MD, Tamborlane, V. William and PHD2 Roy, Anirban PHD2, Voskanyan, Gayane BS1, Carria, Lori Ruiz1, L. Jessica MD1, Kim, Grace Cengiz, Eda Sherr, Jennifer Weinzimer, A. MD

OBJECTIVE Even under closed-loop (CL) conditions, meal-related blood glucose (BG) excursions frequently exceed target levels as a result of delays in absorption of insulin from the subcutaneous site of infusion. We hypothesized that delaying gastric emptying with preprandial injections of pramlintide would improve postprandial glycemia by allowing a better match between carbohydrate and insulin absorptions. RESEARCH DESIGN AND METHODS Eight subjects (4 female; age, 15–28 years; A1C, 7.5 ± 0.7%) were studied for 48 h on a CL insulin-delivery system with a proportional integral derivative algorithm with insulin feedback: 24 h on CL control alone (CL) and 24 h on CL control plus 30-μg premeal injections of pramlintide (CLP). Target glucose was set at 120 mg/dL; timing and contents of meals were identical on both study days. No premeal manual boluses were given. Differences in reference BG excursions, defined as the incremental glucose rise from premeal to peak, were compared between conditions for each meal. RESULTS CLP was associated with overall delayed time to peak BG (2.5 ± 0.9 vs. 1.5 ± 0.5 h; P < 0.0001) and reduced magnitude of glycemic excursion (88 ± 42 vs. 113 ± 32 mg/dL; P = 0.006) compared with CL alone. Pramlintide effects on glycemic excursions were particularly evident at lunch and dinner, in association with higher premeal insulin concentrations at those mealtimes. CONCLUSIONS Pramlintide delayed the time to peak postprandial BG and reduced the magnitude of prandial BG excursions. Beneficial effects of pramlintide on CL may in part be related to higher premeal insulin levels at lunch and dinner compared with breakfast.