From the Guidelines
Amylin plays a crucial role in regulating blood glucose levels by slowing gastric emptying, suppressing glucagon secretion, and promoting satiety. As noted in the study published in Endocrine Reviews in 2018 1, amylin deficiency in type 1 diabetes contributes to the inability to control postprandial glucose levels and has anorexigenic effects. The key functions of amylin include:
- Slowing gastric emptying, resulting in a more gradual rise in blood sugar after meals
- Suppressing glucagon secretion, a hormone that raises blood glucose
- Promoting satiety by acting on the brain to reduce food intake In people with type 1 diabetes, amylin production is absent, while those with type 2 diabetes often have reduced amylin levels. A synthetic analog of amylin called pramlintide is available as an injectable medication for diabetes management, typically administered before meals at doses of 60-120 mcg, as mentioned in the 2017 American Diabetes Association standards of medical care in diabetes 1. This medication helps control post-meal blood sugar spikes, may assist with weight management, and complements insulin therapy. However, pramlintide can cause nausea, especially when starting treatment, and may increase the risk of hypoglycemia when used with insulin, so insulin doses often need adjustment when beginning this therapy. The use of pramlintide has been shown to improve postprandial and overall glucose control, as well as weight loss, in patients with type 1 diabetes, as demonstrated in studies of the amylin analog pramlintide 1.
From the FDA Drug Label
Amylin is colocated with insulin in secretory granules and cosecreted with insulin by pancreatic beta cells in response to food intake. Amylin affects the rate of postprandial glucose appearance through a variety of mechanisms... Amylin slows gastric emptying (i.e., the rate at which food is released from the stomach to the small intestine) without altering the overall absorption of nutrients. In addition, amylin suppresses glucagon secretion (not normalized by insulin alone), which leads to suppression of endogenous glucose output from the liver. Amylin also regulates food intake due to centrally-mediated modulation of appetite
Amylin's main functions are:
- Slowing gastric emptying
- Suppressing glucagon secretion
- Regulating food intake through centrally-mediated modulation of appetite 2
From the Research
Actions of Amylin
- Amylin is a peptide hormone that is co-secreted with insulin from the pancreatic beta-cell 3, 4
- It inhibits postprandial glucagon secretion and delays gastric emptying, thereby modifying postprandial hyperglycaemia in diabetic individuals 3, 4, 5
- Amylin acts as a satiety agent 3
- It regulates the inflow of glucose to the circulation by delaying nutrient delivery and suppressing glucagon secretion in the postprandial period 4
Role of Amylin in Glucose Homeostasis
- Amylin is involved in glucose homeostasis through the inhibition of gastric emptying and postprandial hepatic glucose production, eventually reducing postprandial glucose excursions 6
- It complements insulin's stimulation of the rate of glucose disappearance by slowing the rate of glucose appearance 5
- Endogenous amylin tonically inhibits glucagon secretion and gastric emptying, as demonstrated by the effects of the amylin receptor blocker AC187 5
Amylin Replacement Therapy
- Amylin replacement may improve glycaemic control in diabetes mellitus 3, 6
- A synthetic analogue of human amylin, pramlintide, has been developed and shown to improve glycemic control in diabetic patients 3, 7, 4, 6
- Pramlintide has actions and pharmacokinetic and pharmacodynamic properties similar to the native peptide 3