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.

中文翻译：

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格列本脲、二甲双胍和格列本脲/二甲双胍联合治疗妊娠期糖尿病的药效学。

在妊娠期糖尿病 (GDM) 中，女性无法弥补妊娠期间增加的胰岛素抵抗。关于二甲双胍和格列本脲在妊娠期间的药效学作用的数据有限。本研究利用格列本脲单药治疗（GLY，n = 38）、二甲双胍治疗前和治疗期间的混合膳食耐受试验（MMTT），对 GDM 女性的胰岛素敏感性（SI）、β 细胞反应性和处置指数（DI）进行了表征单一疗法（MET，n = 34），或 GLY 和 MET 联合疗法（COMBO；n = 36）。GLY 显着降低动态 β 细胞反应性 (31%)。MET 和 COMBO 显着增加了 SI（分别为 121% 和 83%）。虽然 GLY、MET 和 COMBO 改善了 DI，但二甲双胍（MET 和 COMBO）表现出更大的 DI 增加（P = 0. 05) 和 MMTT 峰值葡萄糖浓度 (P = 0.03) 比仅服用 GLY 的受试者下降幅度更大。用 MET 最大化 SI，然后用 GLY 增加 β 细胞反应性或补充胰岛素可能是 GDM 管理比单一疗法更佳的策略。