Pharmacodynamics of Glyburide, Metformin, and Glyburide/Metformin Combination Therapy in the Treatment of Gestational Diabetes Mellitus
Year: 2019
Type: article
Abstract: In gestational diabetes mellitus (GDM), women are unable to compensate for the increased insulin resistance during pregnancy. Data are limited regarding the pharmacodynamic effects of metformin and glyburide during pregnancy. This study characterized insulin sensitivity (SI), β-cell responsivity, and disposition index (DI) in women with GDM utilizing a mixed-meal tolerance test (MMTT) before and during treatment with glyburide monotherapy (GLY, n = 38), metformin monotherapy (MET, n = 34), or GLY and MET combination therapy (COMBO; n = 36). GLY significantly decreased dynamic β-cell responsivity (31%). MET and COMBO significantly increased SI (121% and 83%, respectively). Whereas GLY, MET, and COMBO improved DI, metformin (MET and COMBO) demonstrated a larger increase in DI (P = 0.05) and a larger decrease in MMTT peak glucose concentrations (P = 0.03) than subjects taking only GLY. Maximizing SI with MET followed by increasing β-cell responsivity with GLY or supplementing with insulin might be a more optimal strategy for GDM management than monotherapy.
DOI: 10.1002/cpt.1749
Authors: Diana L. Shuster, Laura M. Shireman, Xiaosu Ma, Danny D. Shen, Shannon K. Flood Nichols, Mahmoud S. Ahmed, Shannon Clark, Steve Caritis, Raman Venkataramanan, David M. Haas, Sara K. Quinney, Laura S. Haneline, Alan T. Tita, Tracy A. Manuck, Kenneth E. Thummel, Linda Morris Brown, Zhaoxia Ren, Zane Brown, Thomas R. Easterling, Mary F. Hebert
Institutions: PRA Health Sciences, University of Washington, Eli Lilly (United States), Madigan Army Medical Center, The University of Texas Medical Branch at Galveston, University of Pittsburgh, Indiana University Indianapolis, University of Alabama at Birmingham, University of North Carolina at Chapel Hill, RTI International, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: U.S. Department of Defense, University of Washington, National Institutes of Health, National Institute of General Medical Sciences, National Institute of Child Health and Human Development, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, U.S. Army Medical Department
OpenAlex ID: W2995124319