Post-meal glucose control improved by insulin-plus-amylin artificial pancreas

Jack Woodfield
Mon, 25 Jun 2018
Post-meal glucose control improved by insulin-plus-amylin artificial pancreas
An artificial pancreas system that combines two hormones improves blood sugar levels after meals, new research suggests.

Scientists from the University of Montreal in Canada looked to address a challenge affecting artificial pancreas systems: post-meal blood sugar control. While artificial pancreas systems have been shown to improve glucose levels, postprandial control has varied.

To achieve this, they used Symlin (pramlintide), a synthetic copy of a hormone called amylin, created by the pancreas to regulate blood glucose levels following meals, which is released at the same time as insulin. In people with type 1 diabetes, too little amylin is produced, and some people may produce almost no amylin.

Twenty-eight people with type 1 diabetes were monitored for 24-hour periods using each three different artificial pancreas systems: a dual-hormone pump system containing pramlintide and rapid-acting insulin, a system containing just insulin, or a system containing pramlintide and short-acting (regular) insulin. In the UK, most people with type 1 diabetes take rapid-acting insulin.

An artificial pancreas measures blood glucose levels constantly using a continuous glucose monitor (CGM) linked to an insulin pump, which works out the required amount of insulin to release into the body.

The researchers checked their blood glucose levels at the beginning of the experiments and also at breakfast, lunch and dinner and also following snacks.

They revealed that an artificial pancreas using rapid-acting insulin and pramlintide led to participants were able to maintain within the target glucose range (3.9-10.0 mmol/L) for 86% of the time.

In comparison, the rapid-acting insulin only system led to 74% of the time spent in the target glucose zone, and an artificial pancreas loaded with regular insulin together with pramlintide scored 68%.

People using the dual pump system also saw their mean glucose level drop to 7.4 mmol/L, while the mean glucose levels in the other two groups were of 7.9 mmol/L.

Lead author Dr Ahmad Haidar said: "Our study provides information that using the rapid insulin plus pramlintide is beneficial to patients in controlling post-meal glucose levels�we were impressed by both the extent of improvements, and the lack of side effects, considering these benefits were achieved without increasing the risk of dangerous low glucose levels."

The findings of the research have been presented at the annual conference of the American Diabetes Association.
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