Fixed ratio dosing of pramlintide with regular insulin before a standard meal in patients with type 1 diabetes

Diabetes Obes Metab. 2015 Sep;17(9):904-7. doi: 10.1111/dom.12504. Epub 2015 Jul 8.


Amylin is co-secreted with insulin and is therefore lacking in patients with type 1 diabetes. Replacement with fixed ratio co-administration of insulin and the amylin analogue pramlintide may be superior to separate dosing. This concept was evaluated in a ratio-finding study. Patients with type 1 diabetes were enrolled in a randomized, single-masked, standard breakfast crossover study using regular human insulin injected simultaneously with pramlintide 6, 9 or 12 mcg/unit insulin or placebo. Insulin dosage was reduced by 30% from patients' usual estimates. Plasma glucose, glucagon and pramlintide and adverse events were assessed. All ratios reduced 0-3-h glucose and glucagon increments by >50%. No hypoglycaemia occurred. Adverse events were infrequent and generally mild. All pramlintide/insulin ratios markedly and safely reduced glycaemic excursions and suppressed glucagon secretion in the immediate postprandial state. Further study using one of these ratios to explore the efficacy and safety of longer-term meal-time and basal hormone replacement is warranted.

Trial registration: NCT01708044.

Keywords: amylin; pramlintide; type 1 diabetes.

Publication types

  • Letter
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • Cross-Over Studies
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Drug Therapy, Combination / methods
  • Female
  • Glucagon / blood
  • Glucagon / metabolism
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemic Agents / administration & dosage*
  • Insulin / administration & dosage*
  • Islet Amyloid Polypeptide / administration & dosage*
  • Islet Amyloid Polypeptide / blood
  • Male
  • Meals
  • Middle Aged
  • Postprandial Period
  • Single-Blind Method


  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin
  • Islet Amyloid Polypeptide
  • Glucagon
  • pramlintide

Associated data