Clinical implications of amylin and amylin deficiency

PURPOSE this paper presents an overview of the physiology of glycemic control and t he mechanisms of amylin deficiency in people with diabetes. Benefits of rep lacement therapy with both pramlintide and insulin are discussed. METHODS The discovery of the pancreatic beta-cell hormone amylin, which is cosecret ed with insulin in response to hyperglycemia, has prompted a reanalysis of the mechanisms underlying the control of glucose homeostasis. A review of t he current literature on amylin and amylin deficiency provides the basis of this reanalysis, with a discussion of the clinical implications for people with diabetes. RESULTS Amylin appears to work with insulin to regulate plasma glucose concentratio ns in the bloodstream suppressing the postprandial secretion of glucagon an d restraining the rate of gastric emptying. People with diabetes have a def iciency in the secretion of amylin that parallels the deficiency in insulin secretion, resulting in an excessive inflow of glucose into the bloodstrea m during the postprandial period. CONCLUSIONS While insulin replacement therapy is a cornerstone of diabetes treatment, r eplacement of the function of both amylin and insulin may allow a more comp lete restoration of the normal physiology of glucose control.