Title:A Review of the Efficacy and Cardiovascular Safety of Amylin Analogues
Volume: 16
Issue: 2
Author(s): Rithika Mary Koshy, Cornelius James Fernandez*Koshy Jacob
Affiliation:
- Department of Endocrinology & Metabolism, Pilgrim Hospital, Boston, PE21 9QS,United Kingdom
Keywords:
Amylin analogues, pramlintide, diabetes mellitus, cardiovascular safety, postprandial hyperglucagonemia, glycosylated
haemoglobin, pramlintide.
Abstract: A large proportion of persons with type 1 diabetes mellitus (T1DM) and type 2 diabetes
mellitus (T2DM) do not reach the glycosylated haemoglobin (HbA1c) target of < 7% (53 mmol/-
mol), with an increasing proportion of them being overweight or obese. In both T1DM and T2DM,
there is accelerated gastric emptying and postprandial hyperglucagonemia. Furthermore, insulin
therapy itself is associated with risk of hypoglycemia and weight-gain both of which are barriers to
achieving good control. Medications which can achieve significant HbA1c and weight reduction associated
with an ability to delay gastric emptying and suppress the glucagon secretion with minimal/
no hypoglycemia are of particular interest as an adjuvant to insulin. A synthetic amylin analogue,
pramlintide is a drug with above mentioned properties. Other medications with similar properties
are glucagon-like peptide-1 receptor agonists (GLP-1 RAs). In this article, we will review the
efficacy of pramlintide when given with insulin in improving HbA1c, weight, and cognition with-
/without GLP-1 RAs as well as its cardiovascular (CV) safety.
