Oral contraceptives and diabetes mellitus

Abstract

Objectives: A review of the metabolic effects of oral contraceptives (OCs) in women with insulin-dependent diabetes mellitus (IDDM) and previous gestational diabetes mellitus (GDM).Methods: The effects on glycometabolic control and lipid metabolism were studied in women with well controlled IDDM using low-dose OCs containing ethinyl estradiol combined with norethisterone, levonorgestrel or gestodenc. The hemostatic and endothelial function was also studied in the diabetic women using the gestodene-containing preparation. In women with previous GDM, investigations on insulin sensitivity were performed during intake of a triphasic lowdose oral contraceptive with levenorgestrel.Results: In women with IDDM the glycemic control was not changed by the OCs and none of the treatment regimens were associated with changes in plasma lipids linked to increased risk of atherogenesis. Analysis of the hemostatic balance during intake of the gestodene-containing preparations gave indication of increased fibrin formation which seemed to be compensated by increased fibrinolytic activity. None of the women developed niicroalbutninui-ia during the study. Compared to normal women, reduced insulin sensitivity was found in women with previous GDM using the combined pill.Conclusion: Low-dose OCs do not influence the glycemic control and have no adverse impact on plasma lipids. The balance between fibrin formation and resolution was maintained during intake of- the gestodene-containing pill. Our findings suggest that combined oral contraceptives can be used in women with uncomplicated IDDM and in women with previous GDM if clinical and metabolic monitoring can be ensured to detect progression to frank diabetes.