Mitigating Meal-Related Glycemic Excursions in an Insulin-Sparing Manner During Closed-Loop Insulin Delivery: The Beneficial Effects of Adjunctive Pramlintide and Liraglutide.

Adjunctive pramlintide significantly delayed peak postprandial plasma glucose and reduced glucose excursions and incremental glucose area under the curve during closed-loop insulin delivery. Liraglutide also reduced glucose excursions and incremental glucose AUC, decreased prandial and total daily insulin doses by approximately 26-28%, and induced a mean weight loss of 3.2 kg over 3-4 weeks.

Two outpatient studies were conducted with young adults with type 1 diabetes using closed-loop insulin delivery. Subjects underwent 3-4 weeks of dose escalation of either pramlintide (60 μg/meal) or liraglutide (1.8 mg daily), followed by two 24-hour sessions comparing closed-loop alone versus closed-loop plus adjunctive therapy. Meals were standardized and unannounced during sessions to assess postprandial glucose control.

Improving post-meal blood sugar control without increasing insulin doses can reduce diabetes complications and improve quality of life. These adjunctive therapies offer a promising insulin-sparing approach to enhance closed-loop insulin delivery systems.

The sample sizes were small and limited to young adults with relatively well-controlled type 1 diabetes. The short duration (3-4 weeks) limits understanding of long-term effects and safety. Larger, longer-term studies are needed.