Effect of Hyperglycemia on Gastric Emptying Interactions With Pramlintide

Type 1 Diabetes Clinical Trial

Official title: The Influence of Ambient Glycemia on the Effect of Pramlintide on Gastric Emptying in Patients With Type 1 Diabetes and Healthy Subjects

Status Completed

Clinical Trial Summary

• To examine the influence of acute glycaemia (normoglycaemia and hyperglycaemia) on gastric emptying kinetics in patients with type 1 diabetes and non diabetic subjects when treated with subcutaneous (SC) injections of pramlintide.

Clinical Trial Description

Postprandial increases in plasma glucose concentrations are mainly determined by the degree of postprandial suppression of endogenous glucose production and the rate of appearance of the ingested glucose. The latter is predominantly determined by the amount of glucose taken up by the splanchnic bed. Because nutrient absorption depends on gastric nutrient delivery, gastric emptying rate is a key determinant of the early rise of plasma glucose postprandially. At mealtime, the faster the stomach empties the more rapid the rise in plasma glucose. Yet, plasma glucose concentration is a determinant of gastric emptying rate. In non-diabetic subjects, as plasma glucose rises and approaches the upper limit of the normal range (~140 mg/dl), gastric emptying slows. This likely represents a physiological brake mechanism to limit excess delivery of nutrients, thus avoiding excessive appearance of glucose in plasma. In diabetes, abnormally accelerated gastric emptying as well as delayed gastric emptying have been reported. These conflicting data may be explained by differences of ambient glycaemia. In most of these studies undertaken in diabetic subjects these patients were severely hyperglycaemic, thus the reported delayed gastric emptying may be explained by the effect of hyperglycaemia on gastric motility. Indeed, a small number of studies controlled for ambient glycaemia found acceleration of gastric emptying in diabetes and suggest that diabetes manifests with a maladaptive acceleration of gastric emptying likely contributing to excessive postprandial plasma glucose excursions.

The amylin analog pramlintide is a potential new therapeutic that elicits a potent glucose lowering effect in the postprandial period thought to be due to both a suppression of plasma glucagon and a delay of gastric emptying. It is not clear, however, to what extent the pramlintide-induced delay of gastric emptying offsets a potential maladaptive acceleration of gastric emptying in diabetes patients studied under controlled glycemic conditions. In theory, every drug that reduces hyperglycaemia should accelerate gastric emptying and, thereby, minimize its potential effect on postprandial hyperglycaemia. Thus, the drug-induced effect of amylin on gastric motility may be of great advantage by offset the effects of glycemic induced acceleration on gastric emptying. ;

Study Design

Allocation: Randomized, Endpoint Classification: Pharmacodynamics Study, Intervention Model: Crossover Assignment, Masking: Single Blind (Subject), Primary Purpose: Diagnostic

Related Conditions & MeSH terms

• Diabetes Mellitus, Type 1
• Type 1 Diabetes

• NCT number: NCT00489645
• Study type: Interventional
• Source: Ludwig-Maximilians - University of Munich
• Status: Completed
• Phase: N/A
• Start date: January 2005
• Completion date: April 2007