Oral contraceptives in diabetic women: metabolic effects of four compounds with different estrogen/progestogen profiles

Abstract

The metabolic effects of four oral contraceptives with different estrogen/progestogen profiles (monophasic nonalkylated estrogen/norethindrone, low-dose monophasic ethinyl estradiol (EE2)/norethindrone, progestogen only treatment with norethindrone, and triphasic EE2/levonorgestrel) were examined in insulin-dependent diabetic women. During the 6-month study period, no differences were found in fasting plasma glucose, 24-hour insulin requirements, glycated hemoglobin, free fatty acids, low-density lipoprotein cholesterol concentrations, or high-density lipoprotein cholesterol/total cholesterol ratio between the patients in each treatment group. Compared with the nonalkylated estrogen/norethindrone and the triphasic EE2/levonorgestrel formulations, the low-dose EE2/norethindrone combination resulted in small but significant increases in plasma triglyceride and very low-density lipoprotein cholesterol levels (P less than 0.01), which seemed unfavorable from a clinical point of view. Norethindrone-only treatment appeared to be an appropriate alternative to both the nonalkylated estrogen/norethindrone combination and the triphasic EE2/levonorgestrel formulations.

PIP: The metabolic effects of 4 oral contraceptives (OCs) with different estrogen/progestogen profiles (monophasic nonalkylated estrogen/norethindrone, low-dose monophasic ethinyl estradiol (EE2)/norethindrone, progestogen only treatment with norethindrone, and triphasic EE2/levonorgestrel) were examined in 27 insulin-dependent diabetic women who were assigned at random to 1 of the 4 regimens. The women ranged in age from 17-30 years, and their age range at onset of diabetes was 1-9 years. During treatment, diabetes control was performed by a trained diabetologist. All of the women lived in the Copenhagen (Denmark) city area and had comparable socioeconomic status. None had used hormonal contraceptives for at least the 6 weeks before entering the study. The OCs used were selected in part on the basis of their potency as determined by the pharmacologic profile and in part on the basis of the amount of hormone ingested during 1 treatment cycle. All treatment regimens were administered in 6-month periods. No significant differences in mean body weight were observed between the groups before treatment, and no significant changes were found within the groups during treatment. Before and during treatment, no differences in systolic and diastolic blood pressure were observed between the groups, and the OCs had no influence on the blood pressure in the individual groups. None of the participants experienced specific difficulties with their diabetes control during the hormonal intake. During the 6-month study period, no differences were found in fasting plasma glucose, 24-hour insulin requirements, glycated hemoglobin, free fatty acids, low-density lipoprotein cholesterol concentrations, or high-density lipoprotein cholesterol/total cholesterol ratio between the patients in each treatment group. Compared with the nonalkylated estrogen/norethindrone and the triphasic EE2/levonorgestrel formulations, the low-dose EE2/norethindrone combination resulted in small but significant increases in plasma triglyceride and very low-density lipoprotein cholesterol levels, which seemed unfavorable from a clinical point of view.