Amylin Analog: Symlin (Pramlintide)

The hormone amylin is secreted along with insulin by the pancreatic beta cells in response to food.  Patients with type 1 diabetes may develop an absolute deficiency of both insulin and amylin, and those with type 2 diabetes have impaired secretion of amylin in response to a meal. Pramlintide was developed as an injectable drug and it is very similar in structure to the hormone amylin.

In 2005, Symlin (pramlintide acetate), Amylin Pharmaceuticals’ synthetic analog of human amylin, was approved by the FDA, for use by type 1 and type 2 diabetics who use insulin.

How Symlin works:

The hormone amylin’s role is to suppress glucagon secretion after meals (glucagon increases blood glucose levels.) In people with diabetes, glucagon concentrations are elevated during the post-meal period, contributing to hyperglycemia. Symlin has been shown to decrease post-meal glucagon concentrations in diabetics using insulin.

Symlin slows gastric emptying time, meaning it decreases the rate at which food is released from the stomach to the small intestine after a meal.  The slower release leads to a reduced post-meal rise in plasma glucose, which may last for several hours. 

Symlin enhances satiety.  When taken before a meal, Symlin has been shown to reduce total caloric intake.

In summary, when added to meal-time insulin, Symlin improves glucose control and promotes weight loss in patients with both type 1 and type 2 diabetes.  However, effects on HbA1c reduction are only modest, with 52 week net reduction of 0.27% at 1 year.

Symlin has also been used alone (without insulin), given before meals in people with type 2 diabetes.  In preliminary studies, when compared to patients receiving insulin with meals, these patients were able to achieve similar glucose control with less hypoglycemia and without the weight gain seen with insulin given at meals.

In both patients with type 1 and type 2 diabetes, side effects are mainly nausea, vomiting, and anorexia.  Some reports suggest nausea occurs in up to 25% of patients. Most of the symptoms seem to be transient, gone within the first 4-8 weeks of treatment.

Read About Other Type 2 Diabetes Treatments:

• Biguanides: Metformin
• Sulfonylureas
• Dopamine Agonist: Cycloset (Bromocriptine)
• Treatment of Type 2 Diabetes with Insulin

 Reviewed by Dr. Mariela Glandt, Feb. 2013