Pramlintide: Clinical Strategies for Success

[...] it is equally important to provide training specific to troubleshooting special situations, such as illness or stress, inadequate or omission of insulin dose, inadvertent administration of increased insulin or pramlintide doses, inadequate food intake, or missed meals.8,34 Because pramlintide has the potential to delay the absorption of concomitantly administered oral medications, when the rapid onset of a concomitant orally administered agent is a crucial determinant of effectiveness (such as analgesics), patients should be counseled to take the agent at least 1 hour before or 2 hours after their pramlintide injection. Because of pramlintide's effect on gastric emptying, patients taking drugs that alter gastrointestinal motility (e.g., anticholinergic agents such as atropine) and agents that slow the intestinal absorption of nutrients (e.g., alpha-glucosidase inhibitors) are not candidates for this drug.8 Monitoring Success After patients have been properly educated about normal physiology and the missing hormones in diabetes that are important to optimal glycemic control and pramlintide has been appropriately titrated in conjunction with suitable adjustments to mealtime insulin therapy, appropriate patient outcomes might include: * Diminished daily blood glucose fluctuations * Improved postprandial glycemic control * Additional reductions in A1C * Potential decrease in caloric intake that may result in weight loss * Reductions in doses of total, short-, and long-acting insulin8 * Greater treatment satisfaction for patients with type 1 or type 2 diabetes compared to their counterparts using mealtime insulin without adjunctive pramlintide therapy36,37 Conclusion Amylin receptor agonism is emerging as part of an integrated neurohormonal therapeutic approach for managing diabetes in those patients who are prescribed prandial insulin therapy.