The amylin analogue pramlintide (SYMLIN®) is the first in a new class of injectable amylinomimetic agents to be approved for the treatment of diabetes. This adjunct to insulin treatment of type 1 and type 2 diabetes has recently been approved for use in the USA. Pramlintide, unlike native amylin is soluble. It acts mainly via central effects (area postrema) resulting in deceased glucagon secretion, slowing gastric emptying and a satiety effect. It is injected subcutaneously separately from insulin, and usually before each of the main meals. It has been shown to improve glycaemic control without causing weight gain but the dose must be titrated slowly in association with appropriate insulin adjustments to guard against insulin-induced hypoglycaemia and nausea. Thus, pramlintide is an injected amylin replacement therapy that can be used with an insulin regimen to improve glycaemic control without weight gain.
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