Pramlintide

The only FDA-approved amylin analog. Modest weight loss and glucose-smoothing effects, but three-times-daily dosing limits adoption.

A rough internal score reflecting quantity, quality, and consistency of human evidence. Not a clinical recommendation.

FDA-approved since 2005. Clinical trials showed reduced postprandial glucose excursions and modest weight loss (1–2 kg) when added to insulin. Requires careful insulin dose adjustment to avoid hypoglycemia. Commercial uptake has been limited by injection frequency.

• FDA-approved with established safety profile
• Reduces postprandial glucose spikes
• Modest weight loss as add-on to insulin

Type 2: 120 mcg before major meals. Type 1: 15–60 mcg before meals, titrated.

• Nausea
• Hypoglycemia (with insulin)
• Headache
• Anorexia

Must reduce prandial insulin dose by 50% when initiating to avoid hypoglycemia. Contraindicated in gastroparesis. Requires injection before each meal.

Weight loss is modest. The need for premeal injection alongside insulin reduces practicality.

• Weight loss40