Abstract

PIP: The obvious need for highly effective contraception in women with existing disorders of glucose metabolism has led to a search for oral contraceptive (OC) regimens for such women that are efficient but without unacceptable metabolic side effects. Recent studies have indicated that low-dose OCs can be administered to women of normal weight with previous gestational diabetes mellitus without the risk of a deterioration in glucose tolerance. The present study found that, in both women with previous gestational diabetes mellitus and normal women, triphasic OCs resulted in a significantly lower insulin response to oral glucose than the low-dose monophasic estradiol/levonorgestrel formulation. This finding suggests that the progestogen component of OCs is largely responsible for the influence of OCs on glucose homeostasis. In women of normal weight with previous gestational diabetes mellitus, there is no apparent direct association between glucose tolerance, plasma insulin levels, and insulin binding to erythrocytes and monocytes during intake of low-dose OCs; in addition, there is no adverse effect on lipid/lipoprotein levels. In women with insulin-dependent diabetes mellitus, combined OCs (estradiol-estriol/norethisterone) appear to have no adverse effects on the diabetic control; however, low-dose artificial OCs are without any influence on glycemic control in these women. Treatment with norethisterone alone appears to be an appropriate alternative to both the nonalkylated estrogen/norethisterone combinations and triphasic OCs. More longterm studies are needed regarding the effects on glucose and lipoprotein metabolism to predict the clinical significance on the occurrence of cardiovascular diseases and the deterioration of glycemic control in women with insulin-dependent diabetes and previous gestational diabetes.