Subdermal Progestin Implant and an Oral Combined Hormonal Contraceptive in Youth with Type 1 Diabetes

Abstract

Study ObjectiveTo determine the metabolic effects of the subcutaneous etonogestrel implant compared to an oral contraceptive in adolescents and young adults (AYA) with T1D on body weight, body composition, glucose, lipids, and C-reactive protein levels (CRP). MethodsNon-randomized, interventional, prospective study. Thirty-nine AYA with T1D participated; twenty used the implant (Implant-T1D), and nineteen used an oral combined contraceptive (OC-T1D). Body composition, HbA1c, intermittent continuous glucose monitoring (CGM), lipids, and high sensitivity C-reactive protein (hsCRP) levels were evaluated. ResultsAll participants were followed for at least 12 months, and twenty-six completed the 24-month follow-up. No women discontinued the intervention due to side effects. Body weight increased by 0.8 ± 3.5 kg and 1 ± 2.9 kg in the OC-T1D and the Implant-T1D group at 12 months and by 2.6 ± 3.9 kg and 3.3 ± 3.6 kg at 24 months, respectively. OC-T1D and Implant-T1D had similar HbA1c, mean interstitial glucose levels, and time in range throughout the study; no significant difference over time was observed. hsCRP levels increased in both groups and were associated with BMI and HbA1c (p<0.001 for both variables). Women in the OC-T1D group had higher total cholesterol, HDL-C, and triglyceride levels compared with the Implant-T1D. ConclusionGlucose levels were similar in youth using the subdermal progestin implant and an OC. However, both AYA groups showed increased BMI, fat mass, and subclinical inflammation. Changes in lipid levels were associated with the OC method. These data highlight the importance of weight gain prevention in young women with T1D using hormonal contraception.