GLP-1 & incretin

Pramlintide

A synthetic amylin analogue licensed in the US as an addition to mealtime insulin in type 1 and type 2 diabetes.

Strong evidenceApproved drugAdd to compare

What it is

Pramlintide is a synthetic analogue of human amylin, a 37-amino-acid hormone released from beta cells alongside insulin. Three substitutions make it soluble and slow to clump, which is what makes it usable as an injection. It is licensed in the US (Symlin) for use with mealtime insulin; it has no EU authorisation.

How it works

1
Slows gastric emptying, so glucose from a meal arrives more gradually.
2
Suppresses glucagon release in a glucose-dependent manner, reducing hepatic glucose output after meals.
3
Signals satiety centres in the hindbrain, reducing intake.
4
Works alongside insulin rather than replacing it, smoothing the post-meal glucose curve.
5
Amylin receptors are formed from calcitonin receptor plus receptor-activity-modifying proteins.

What it's studied for

Type 1 diabetes as an adjunct to insulin

Type 2 diabetes on insulin therapy

Postprandial glucose control

Weight change in insulin-treated diabetes

Gastric emptying research

Reported and studied effects

HbA1c reductions of roughly 0.3 to 0.6 percentage points
Clearly blunted post-meal glucose rise
Weight loss of about 1 to 2 kg in trials
Increased fullness and reduced intake
Frequent nausea limits dose escalation for some people

Research protocol notes

Research context only

Research context only - prescription medicine. US labelling starts at 15 micrograms subcutaneously before major meals in type 1 diabetes (60 micrograms in type 2) and escalates in 15-microgram steps to a maximum of 60 micrograms as tolerated, with mealtime insulin usually reduced to avoid hypoglycaemia. Trial durations ran 26 to 52 weeks.

These figures are described so you can understand what researchers did. They are not a dose, a schedule, or a suggestion — and they are not a substitute for a doctor.

Possible side effects and contraindications

Safety profile

Possible side effects

Nausea, very common and dose-related
Vomiting and anorexia
Headache
Hypoglycaemia, particularly in type 1 diabetes
Injection-site reactions
Reduced appetite severe enough to affect nutrition

Contraindications and cautions

Confirmed gastroparesis
Hypoglycaemia unawareness
Poor adherence to insulin or self-monitoring
Prior serious hypersensitivity
Pregnancy - insufficient data

A side-effect list is never complete, and these are not the only situations that warrant caution. Anything unexpected, or anything you are unsure about, should be discussed with a doctor before use.

Evidence assessment

Strong evidenceReplicated, large human trials

Replicated, large human trials

Several randomised controlled trials in type 1 and type 2 diabetes with HbA1c as the primary endpoint, leading to FDA approval in 2005.

References

References link to published literature, regulator pages or literature indexes. Where a link points to a search, it collects the peer-reviewed work on that molecule rather than a single study.

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Cagrilintide

A long-acting amylin analogue that slows digestion and reduces appetite, studied alone and combined with semaglutide for obesity.

Moderate evidenceInvestigational

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Dulaglutide

A once-weekly GLP-1 receptor agonist approved for type 2 diabetes, with proven cardiovascular benefit in people at high risk.

Strong evidenceApproved drug

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Exenatide

A GLP-1 receptor agonist derived from Gila monster saliva, approved for type 2 diabetes in twice-daily and once-weekly forms.

Strong evidenceApproved drug