Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun;24(6):1021-1028.
doi: 10.1111/dom.14665. Epub 2022 Mar 9.

Pramlintide for post-bariatric hypoglycaemia

Amanda Sheehan  1 , Allison Goldfine  1   2 , Muhammed Bajwa  1 , Danielle Wolfs  1 , Chisayo Kozuka  1   2 , Jacqueline Piper  1 , Kristen Fowler  1 , Mary Elizabeth Patti  1   2
Affiliations

Pramlintide for post-bariatric hypoglycaemia

Amanda Sheehan et al. Diabetes Obes Metab. 2022 Jun.

Abstract

Aims: The aim of this study was to examine the hypothesis that pramlintide would reduce hypoglycaemia by slowing gastric emptying and reducing postprandial glucagon secretion, thus limiting postprandial glycaemic excursions and insulin secretion, and thus to determine the efficacy of pramlintide on frequency and severity of hypoglycaemia in post-bariatric hypoglycaemia (PBH).

Materials and methods: Participants with PBH following gastric bypass were recruited from outpatient clinics at the Joslin Diabetes Center, Boston, Massachusetts for an open-label study of pramlintide efficacy over 8 weeks. Twenty-three participants were assessed for eligibility, 20 participants had at least one pramlintide dose, and 14 completed the study. A mixed-meal tolerance test (MMTT) was performed at baseline and after 8 weeks of subcutaneous pramlintide with a sequential dose increase to a maximum of 120 micrograms (mean 69 ± 32 mcg) three times daily. The primary endpoint was change in glucose excursions during the MMTT. Secondary measures included MMTT insulin response, satiety and dumping score, percentage time with sensor glucose (SG) <3.9 mM, and number of days with minimum SG <3 mM, during masked continuous glucose monitoring.

Results: There were no differences in MMTT glucose, glucagon or insulin between baseline and post treatment. We observed no significant change in satiety or dumping scores. The overall frequency of low SG values did not change, although there was substantial inter-individual variability.

Conclusions: In PBH, pramlintide does not modulate glycaemic or insulin responses, satiety, or dumping scores during an MMTT and does not impact glycaemic excursions or decrease low SG levels in the outpatient setting.

Keywords: bariatric surgery; continuous glucose monitoring (CGM); glucagon; hypoglycaemia.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
A. Plasma glucose (mg/dl) during liquid mixed meal at the baseline visit and after pramlintide therapy for 8 weeks with pramlintide dosed 15 minutes pre-meal (A. n=14); B. Plasma insulin (uIU/ml) during liquid mixed meal at the baseline visit (V2) and after pramlintide therapy for 8 weeks with pramlintide dosed 15 minutes pre-meal (V4) (B. n=11); C. Plasma glucagon (pmol/L) during liquid mixed meal at the baseline visit (V2) and after pramlintide therapy for 8 weeks with pramlintide dosed 15 minutes pre-meal (V4) (C. n= 8).
Figure 2:
Figure 2:
A. Mean sensor glucose (mg/dl) at baseline and after 8 weeks of pramlintide. B. % Time with sensor glucose <70 mg/dl at baseline and after 8 weeks of pramlintide. For both panels, V2: (n=13), V4: (n= 11).
Figure 3:
Figure 3:
Change in percent time sensor glucose <70 mg/dL between baseline and during pramlintide therapy (n=10).
See this image and copyright information in PMC

References

    1. Carlsson LMS, Sjöholm K, Jacobson P, et al. Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study. The New England journal of medicine. 2020;383(16). - PMC - PubMed
    1. Seeley RJ, Chambers AP, Sandoval DA. The role of gut adaptation in the potent effects of multiple bariatric surgeries on obesity and diabetes. Cell Metab. 2015;21(3):369–378. - PMC - PubMed
    1. Mingrone G, Panunzi S, De Gaetano A, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial. Lancet (London, England). 2021;397(10271). - PubMed
    1. Courcoulas A, Coley RY, Clark JM, et al. Interventions and Operations 5 Years After Bariatric Surgery in a Cohort From the US National Patient-Centered Clinical Research Network Bariatric Study. JAMA surgery. 2020;155(3). - PMC - PubMed
    1. Salehi M, Vella A, McLaughlin T, Patti ME. Hypoglycemia After Gastric Bypass Surgery: Current Concepts and Controversies. J Clin Endocrinol Metab. 2018;103(8):2815–2826. - PMC - PubMed

MeSH terms