Carbohydrate Metabolism In Women Research Articles

Indicators of carbohydrate metabolism and vitamin D levels in pregnant women with metabolic syndrome

The objective: to assess the level of vitamin D and its relationship with carbohydrate metabolism in women with metabolic syndrome in the I trimester of pregnancy. Materials and methods. 120 pregnant women were examined, of which 60 patients were diagnosed with metabolic syndrome before pregnancy (main group) and 60 patients without this pathology (control group). All women were measured for fasting blood glucose, glycated hemoglobin, immunoreactive insulin, HOMA-IR index, and serum vitamin D levels. Results. In women in the main group, the average level of vitamin D was 15.76±3.77 ng/ml, in the control group – 17.20±3.76 ng/ml. The concentration of vitamin D less than 20 ng/ml in the main group was found in 70.0% of patients, in the control group – in 51.7%, 20–30 ng/ml – in 30.0% and 48.3%, respectively (p<0.05). The mean body mass index was significantly higher in women of the main group relative to the control group (p=0.041) and in patients with metabolic syndrome did not differ from the values in women with vitamin D deficiency and insufficiency. However, body mass index was significantly higher in the presence of vitamin D deficiency between patients with and without metabolic syndrome (p=0.001). There was a significant difference in the concentration of immunoreactive insulin and the value of the HOMA-IR index between pregnant women with vitamin D deficiency and metabolic syndrome (p=0.040) and without it (p=0.023). Serum 25(OH)D levels in early pregnancy in persons with metabolic syndrome positively correlated with glucose (r=0.361; p>0.05), HbA1c (r=0.355; p>0.05) and HOMA-IR (r=0.239; p>0.05) in vitamin D deficiency and negative in 25(OH)D insufficiency: r=-0.795 (p<0.05), r=-0.464 (p>0.05) and r=-0.500 (p>0.05), respectively.Conclusions. Pregnant women with metabolic syndrome and vitamin D deficiency, compared with pregnant women without this syndrome, may have higher levels of immunoreactive insulin and HOMA-IR index. Between the women with the deficiency and insufficiency of vitamin D and the parameters of carbohydrate metabolism in the metabolic syndrome a multidirectional correlation was revealed.

Уровень витамина D и показатели углеводного обмена у женщин с синдромом поликистозных яичников

Актуальность. Синдром поликистозных яичников (СПКЯ) остается актуальной проблемой гинекологической эндокринологии, а его частота составляет примерно 11–17 % среди женщин репродуктивного возраста и достигает 75 % в структуре эндокринного бесплодия. Существуют доказательства, что витамин D влияет на обмен углеводов, а его недостаточность или дефицит повышают риск развития нарушения толерантности к глюкозе, инсулинорезистентности и сахарного диабета 2-го типа. Цель: определить связь между уровнем витамина D и показателями углеводного обмена у женщин с синдромом поликистозных яичников. Материалы и методы. Обследовано 60 женщин в возрасте от 19 до 26 лет: 30 женщин с диагнозом классического фенотипа СПКЯ; 30 здоровых женщин с нормальной менструальной и репродуктивной функцией. Исследовали содержание витамина D, секcстероид­связывающего глобулина (СССГ), иммунореактивного инсулина (ИРИ), индекс НОМА-IR, индекс массы тела (ИМТ), окружность талии/окружность бедер (ОТ/ОБ). В зависимости от концентрации витамина D обследованные были разделены на подгруппы: первая — 22 больные СПКЯ с витамином D ≤ 30 нг/мл (средний уровень — 12,9 ± 0,2 нг/мл); вторая — 8 больных с уровнем витамина D ≥ 30 нг/мл (31,4 ± 0,3 нг/мл); третья — 12 здоровых женщин с витамином D ≤ 30 нг/мл (24,2 ± 0,3 нг/мл); четвертая — 18 здоровых обследованных с уровнем витамина D ≥ 30 нг/мл (35,6 ± 0,3 нг/мл). Результаты. Установлено, что в общей группе пациенток с СПКЯ средний уровень витамина D (21,4 ± 0,4 нг/мл) был достоверно ниже (Р < 0,001) по сравнению с показателем группы здоровых женщин (29,6 ± 0,3 нг/мл). У больных с СПКЯ низкие концентрации витамина D сопровождались более высокими уровнями глюкозы (Р < 0,001), ИРИ (Р < 0,001), индекса НОМА-IR (Р < 0,001) и снижением СССГ (Р < 0,001). Установлена негативная ассоциативная связь витамина D с ИМТ (r = –0,399; Р < 0,05), ОТ/ОБ (r = –0,612; Р < 0,001), концентрацией ИРИ (r = –0,502; р < 0,001), показателем индекса НОМА-IR (r = –0,571; Р < 0,001), уровнем СССГ (r = –0,694; Р < 0,001). Выводы. Показана роль абдоминального ожирения в формировании дефицита витамина D, который усиливает нарушения углеводного обмена, а именно увеличивает гиперинсулинемию, инсулинорезистентность и снижает продукцию сексстероидсвязывающего глобулина у женщин с СПКЯ.

Carbohydrate metabolism in women with metabolic syndrome with multimodal non-drug correction of menopausal disorders

Purpose of workTo study the effect of non-pharmacological correction on carbohydrate metabolism in women with menopausal disorders against the background of metabolic syndrome. Materials and methods330 women 45–50 years old with menopausal disorders during the menopausal transition and metabolic syndrome (MS) are ranked in 5 groups. Group I used: basic treatment, physiotherapy, balneotherapy, multivitamins and minerals, as well as physiotherapeutic factors (vibration therapy, chromotherapy, melotherapy, aromatherapy, aeroionotherapy). In group II, chromotherapy was excluded from the above methods, in group III - vibration therapy, in group IV physiotherapy was not used, in group V only basic treatment was used. The levels of glucose, serum insulin, and the HOMA-IR index (Homeostasis Model Assessment-Insulin Resistance) were determined. ResultsThe inclusion of physical factors in the treatment complex significantly improved carbohydrate metabolism. The simultaneous use of all these physical factors allowed the most significant decrease in the HOMA-IR index after 6 months of therapy in patients with mild climacteric syndrome by 56,2 %, in patients with moderate climacteric syndrome by 57,2 %, respectively (p < 0,0001). The decrease in the total Green test score was 55,3 % and 39,9 %, respectively (p < 0,0001). ConclusionNon-drug complex programs with physiotherapy improve carbohydrate metabolism and contribute to the regression of menopausal disorders in women with metabolic syndrome during the menopausal transition. The priority is the simultaneous use of vibration therapy, chromotherapy, melotherapy, aromatherapy and aeroionotherapy.

Pericardial Fat Relates to Disturbances of Glucose Metabolism in Women with the Polycystic Ovary Syndrome, but Not in Healthy Control Subjects.

Objective The objective of the present study is to investigate the relationship of cardiac fat depots with disturbances of the carbohydrate metabolism in women with PCOS. Methods An oral glucose tolerance test (OGTT) was realized, and metabolic parameters were collected in 48 women with PCOS and in 20 controls. Intramyocardial fat (MYCL) and pericardial fat (PERI) were measured using 1H-magnetic resonance spectroscopy and imaging. Results Only in PCOS women, PERI was positively and independently related to parameters of glucose metabolism (HbA1c: p = 0.001, fasting plasma glucose: p < 0.001, stimulated glucose at 30 and 60 minutes in the OGTT). Thus, the disposition index, insulin sensitivity, and adiponectin also declined with the increase of PERI in women with PCOS; however, these results were not independent of BMI and age. In addition, PERI was positively related to atherogenic lipid profiles, BMI, waist circumference, CRP, and liver fat in women with PCOS. A negative relation of PERI with triglycerides and a positive relation with BMI and waist circumference could be observed in the controls. No relationship of MYCL with diabetes-specific parameters could be found in the study population. Conclusion PERI is related to metabolic disturbances in women with PCOS, but not in metabolically healthy lean subjects. This clinical trial was registered at ClinicalTrials.gov and has the registration number NCT03204461.

Effect of vibration therapy on fasting glucose, insulin level and HOMA2 score in women with pre-diabetes history

Introduction: Low frequency vibrations affect the whole body. It’s proposed that they can be an effective tool to improve glycemia by the activation of a large number of muscle fibers. The therapy effectiveness depends on the use of a stimulus characterized by appropriate parameters (frequency, amplitude, time) and proper propagation. Aim of the study: The aim of the study was to evaluate the effect of a series of 21 treatments using oscillating-cycloid vibrations on carbohydrate metabolism in women over 55 years with history of fasting hyperglycaemia in their medical history. Material and methods: The study involved 50 women (age: 67.0 ± 5.9) randomly assigned to groups. The study group was subjected to 21 vibration therapy interventions, the control group participated in the procedures using specially modified placebo devices. Before the start of the treatment and on days 10 and 21, glucose and insulin levels were measured and then HOMA2IR, HOMA% B and HOMA% S. were calculated. Results: After 21 days of vibrations, a significant decrease in insulin concentration was noted in the experimental group (from 21.9 ± 11.2 μIU / ml to 12.8 ± 2.7 μIU / ml). This effect was confirmed by the change in the HOMA2IR index. Conclusions: The stimulus applied in the form of 21 vibration treatments seems to be a promising form of therapy in the studied group. These results indicate the need for further testing with addition of nutrition control.

Circadian Rhythms of Carbohydrate Metabolism in Women with Different Types of Obesity.

Blood levels of glucose and immunoreactive insulin were assessed in women with android and gynoid types of obesity or normal body weight (control group) in the dynamics of oral glucose tolerance test in the morning and in the evening. In the control group, the mean concentrations of glucose and immunoreactive insulin were significantly higher in the evening at all test terms (0, 60 and 120 min), which is indicative of physiological insulin resistance in the evening. In the group of women with gynoid obesity, no difference in the levels of glucose and immunoreactive insulin was revealed in the morning and evening tests, but in the evening tests, glucose (60 and 120 min) and immunoreactive insulin (120 min) levels were lower than in the control group. In the group of women with android obesity, the evening glucose level on minutes 60 and 120 of the test was higher than in the morning, but immunoreactive insulin did not vary throughout the day and on minutes 60 and 120 it surpassed the corresponding parameter in the control group by 2-4 times. In case of gynoid obesity, glucose load was followed by hyperinsulinemia and hypoglycemia; in android obesity, it was followed by hyperinsulinemia, hyperglycemia, and insulin resistance irrespective of the time of the day.

Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus.

Many hormonal contraceptives have been associated with changes in carbohydrate metabolism. Alterations may include decreased glucose tolerance and increased insulin resistance, which are risk factors for Type 2 diabetes mellitus and cardiovascular disease. These issues have been raised primarily with contraceptives containing estrogen. To evaluate the effect of hormonal contraceptives on carbohydrate metabolism in healthy women and those at risk for diabetes due to overweight. In April 2014, we searched the computerized databases MEDLINE, POPLINE, CENTRAL, and LILACS for studies of hormonal contraceptives and carbohydrate metabolism. We also searched for clinical trials in ClinicalTrials.gov and ICTRP. The initial search also included EMBASE. All randomized controlled trials were considered if they examined carbohydrate metabolism in women without diabetes who used hormonal contraceptives for contraception. Comparisons could be a placebo, a non-hormonal contraceptive, or another hormonal contraceptive that differed in drug, dosage, or regimen. Interventions included at least three cycles. Outcomes included glucose and insulin measures. We assessed all titles and abstracts identified during the literature searches. The data were extracted and entered into RevMan. We wrote to researchers for missing data. For continuous variables, the mean difference (MD) was computed with 95% confidence interval (CI) using a fixed-effect model. For dichotomous outcomes, the Peto odds ratio with 95% CI was calculated. We found 31 trials that met the inclusion criteria. No new trials were eligible in 2014. Twenty-one trials compared combined oral contraceptives (COCs); others examined different COC regimens, progestin-only pills, injectables, a vaginal ring, and implants. None included a placebo. Of 34 comparisons, eight had any notable difference between the study groups in an outcome.Twelve trials studied desogestrel-containing COCs, and the few differences from levonorgestrel COCs were inconsistent. A meta-analysis of two studies showed the desogestrel group had a higher mean fasting glucose (MD 0.20; 95% CI 0.00 to 0.41). Where data could not be combined, single studies showed lower mean fasting glucose (MD -0.40; 95% CI -0.72 to -0.08) and higher means for two-hour glucose response (MD 1.08; 95% CI 0.45 to 1.71) and insulin area under the curve (AUC) (MD 20.30; 95% CI 4.24 to 36.36).Three trials examined the etonogestrel vaginal ring and one examined an etonogestrel implant. One trial showed the ring group had lower mean AUC insulin than the levonorgestrel-COC group (MD -204.51; 95% CI -389.64 to -19.38).Of eight trials of norethisterone preparations, five compared COCs and three compared injectables. In a COC trial, a norethisterone group had smaller mean change in glucose two-hour response than a levonorgestrel-COC group (MD -0.30; 95% CI -0.54 to -0.06). In an injectable study, a group using depot medroxyprogesterone acetate had higher means than the group using norethisterone enanthate for fasting glucose (MD 10.05; 95% CI 3.16 to 16.94), glucose two-hour response (MD 17.00; 95% CI 5.67 to 28.33), and fasting insulin (MD 3.40; 95% CI 2.07 to 4.73).Among five recent trials, two examined newer COCs with different estrogen types. One showed the group with nomegestrel acetate plus 17β-estradiol had lower means than the levonorgestrel group for incremental AUC glucose (MD -1.43; 95% CI -2.55 to -0.31) and glycosylated hemoglobin (HbA1c) (MD -0.10; 95% CI -0.18 to -0.02). Two trials compared extended versus conventional (cyclic) regimens. With a dienogest COC, an extended-use group had greater mean change in AUC glucose (MD 82.00; 95% CI 10.72 to 153.28). In a small trial using two levonorgestrel COCs, the lower-dose group showed smaller mean change in fasting glucose (MD -3.00; 95% CI -5.89 to -0.11), but the obese and normal weight women did not differ significantly. Current evidence suggests no major differences in carbohydrate metabolism between different hormonal contraceptives in women without diabetes. We cannot make strong statements due to having few studies that compared the same types of contraceptives. Many trials had small numbers of participants and some had large losses. Many of the earlier studies had limited reporting of methods.We still know very little about women at risk for metabolic problems due to being overweight. More than half of the trials had weight restrictions as inclusion criteria. Only one small trial stratified the groups by body mass index (obese versus normal).

Effect of a new oral contraceptive with estradiol valerate/dienogest on carbohydrate metabolism

BackgroundInsulin resistance may be induced by both the estrogen and progestin component in hormonal contraception. When estrogen dose is reduced from 50 to 20 mcg, the extent of hyperinsulinemia decreases. Recently, the oral combination contraceptive (COC) containing estradiol valerate (E2V) in combination with dienogest (DNG) was developed in a new estrogen step-down, progesterone step-up dosing strategy (Qlaira, Bayer Healthcare Pharmaceuticals). This study was conducted to evaluate of the effect of a 3-month treatment with E2V/DNG on carbohydrate metabolism in women with polycystic ovarian syndrome (PCOS) and insulin resistance. Study DesignStudy consisted of subjects attending the gynecological clinic of Siena or Pisa, with PCOS and insulin resistance, and without contraindications for the use of COCs. PCOS females (n=20) aged 18 to 33 years were treated with a contraceptive formulation containing E2V/DNG for 3 months. Before treatment and during the third month of therapy, body mass index (BMI) measurement and an oral glucose tolerance test (OGTT) were performed. ResultsMedian values of insulin after treatment were lower than median values before treatment. In particular, the median value of insulin at T0 was reduced by 54.6% (p<.001), and the mean difference between time 0 and 30 min was significantly reduced [42.96 (9.99) mU/mL vs 38.00 (15.10) mU/mL; p<.05]. Homeostasis model assessment of insulin resistance levels were significantly decreased following treatment. OGTT after treatment revealed median fasting glucose levels to be stable (p=.895) at T0. At T30, T60, T120 and T180 min, glucose median values were moderately reduced in comparison to median values before treatment. No significant difference was observed between median BMI values before [26 (4.8) kg/m2] and after treatment [26 (3.7) kg/m2]. ConclusionsMedian insulin levels at T0 and the mean difference between time 0 and 30 of insulin following OGTT were significantly reduced than values before treatment with E2V/DNG for 3 months. Median BMI and glucose levels were not significantly modified. Natural estradiol and nonandrogenic progestogen in the Qlaira formulation could be recommended as an oral contraceptive in women with PCOS who are insulin resistant or who are overweight.

Hormonal versus non-hormonal contraceptives in women with diabetes mellitus type 1 and 2

Adequate contraceptive advice is important in both women with diabetes mellitus type 1 and type 2 to reduce the risk of maternal and infant morbidity and mortality in unplanned pregnancies. A wide variety of contraceptives are available for these women. However, hormonal contraceptives might influence carbohydrate and lipid metabolism and increase micro- and macrovascular complications, so caution in selecting a contraceptive method is required. To investigate whether progestogen-only, combined estrogen and progestogen or non-hormonal contraceptives differ in terms of effectiveness in preventing pregnancy, in their side effects on carbohydrate and lipid metabolism, and in long-term complications such as micro- and macrovascular disease when used in women with diabetes mellitus. The search was performed in CENTRAL, MEDLINE, EMBASE, POPLINE, CINAHL, WorldCat, ECO, ArticleFirst, the Science Citation Index, the British Library Inside, and reference lists of relevant articles. The last search was performed in January 2013. In addition, experts in the field and pharmaceutical companies marketing contraceptives were contacted to identify published, unpublished or ongoing studies. Randomised and quasi-randomised controlled trials that studied women with diabetes mellitus comparing: 1. hormonal versus non-hormonal contraceptives; 2. progestogen-only versus estrogen and progestogen contraceptives; 3. contraceptives containing < 50 µg estrogen versus contraceptives containing ≥ 50 µg estrogen; and 4. contraceptives containing first-, second- and third-generation progestogens, drospirenone and cyproterone acetate. The principal outcomes were contraceptive effectiveness, diabetes control, lipid metabolism and micro- and macrovascular complications. Two investigators evaluated the titles and abstracts identified from the literature search. Quality assessment was performed independently with discrepancies resolved by discussion or consulting a third review author. Because the trials differed in studied contraceptives, participant characteristics and methodological quality, we could not combine the data in a meta-analysis. The trials were therefore examined on an individual basis and narrative summaries were provided. Four randomised controlled trials were included. No unintended pregnancies were reported during the study periods. Only one trial was of good methodological quality. It compared the influence of a levonorgestrel-releasing intrauterine device (IUD) versus a copper IUD on carbohydrate metabolism in women with type 1 diabetes mellitus. No significant difference was found between the two groups. The other three trials were of limited methodological quality. Two compared progestogen-only pills with different estrogen and progestogen combinations, and one also included the levonorgestrel-releasing IUD and copper IUD. The trials reported that blood glucose levels remained stable during treatment with most regimens. Only high-dose combined oral contraceptives and 30 µg ethinylestradiol + 75 µg gestodene were identified as slightly impairing glucose homeostasis. The three studies found conflicting results regarding lipid metabolism. Some combined oral contraceptives appeared to have a minor adverse effect while others appeared to slightly improve lipid metabolism. The copper IUD and progestogen-only oral contraceptives also slightly improved lipid metabolism and no influence was seen while using the levonorgestel-releasing IUD. Only one study reported on micro- and macrovascular complications. It observed no signs or symptoms of thromboembolic incidents or visual disturbances, however study duration was short. Only minor adverse effects were reported in two studies. The four included randomised controlled trials in this systematic review provided insufficient evidence to assess whether progestogen-only and combined contraceptives differ from non-hormonal contraceptives in diabetes control, lipid metabolism and complications. Three of the four studies were of limited methodological quality, sponsored by pharmaceutical companies and described surrogate outcomes. Ideally, an adequately reported, high-quality randomised controlled trial analysing both intermediate outcomes (that is glucose and lipid metabolism) and true clinical endpoints (micro- and macrovascular disease) in users of combined, progestogen-only and non-hormonal contraceptives should be conducted. However, due to the low incidence of micro- and macrovascular disease and accordingly the large sample size and long follow-up period needed to observe differences in risk, a randomised controlled trial might not be the ideal design.

Hemoglobin A1c Versus Oral Glucose Tolerance Test in Postpartum Diabetes Screening

OBJECTIVETo determine the usefulness of measuring hemoglobin A1c (A1C), alone or combined with the fasting glucose test, compared with the oral glucose tolerance test (OGTT) for the reassessment of the carbohydrate metabolism status in postpartum women with a history of gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODSWe evaluated the status of carbohydrate metabolism by performing the OGTT and fasting glucose and A1C tests in 231 postpartum women with prior GDM 1 year after delivery.RESULTSThe prevalence of abnormal carbohydrate metabolism was 45.89% by the OGTT criterion, 19.05% by the A1C test criterion, 38.10% by the fasting glucose test criterion, and 46.75% by the A1C-fasting glucose test criteria. Using the OGTT as the gold standard, abnormal carbohydrate metabolism according to the A1C test criterion had 22.64% sensitivity and 54.55% positive predictive value; abnormal carbohydrate metabolism by the fasting glucose criterion had 83.02% sensitivity and 100% positive predictive value. The A1C-fasting glucose test criteria classified 18 women with normal carbohydrate metabolism as having abnormal carbohydrate metabolism. Abnormal carbohydrate metabolism by the A1C-fasting glucose test criteria had 83.02% sensitivity and 81.48% positive predictive value.CONCLUSIONSOur results seem to indicate that the A1C test criterion alone or in combination with fasting glucose test criterion does not provide a sensitive and specific diagnosis of abnormal carbohydrate metabolism in women who have had GDM.

The value of hemoglobin A1c for diagnosis of diabetes mellitus and other changes in carbohydrate metabolism in women with recent gestational diabetes mellitus

Abstract Introduction Women with gestational diabetes mellitus (GDM) have an increased risk for developing diabetes mellitus (DM). Their postpartum metabolic classification using a 75 g oral glucose tolerance test (75 g OGTT) is recommended. The purpose of this study was to assess the value of hemoglobin A1c for postpartum evaluation in women with recent GDM. Patients and methods Fifty-six women with recent GDM underwent a 75 g OGTT at our center to assess postpartum changes in carbohydrate metabolism and were classified using diagnostic criteria of the American Diabetes Association (ADA). Receiver operating characteristic (ROC) curves analysis was used to assess the diagnostic performance of hemoglobin A1c, and kappa index was used to evaluate diagnostic agreement between hemoglobin A1c and 75 g OGTT. Results DM was diagnosed in 7 women, and other categories of increased risk for DM in 25 women. Kappa index for diagnosis agreement was 0.22. Hemoglobin A1c ≥ 5.7% had 47% sensitivity and 71% specificity for identifying any change in carbohydrate metabolism. A hemoglobin A1c value ≥ 6.5 had 29% sensitivity and 100% specificity for diagnosis of DM. Area under the ROC curve was 0.57 for identifying any change in carbohydrate metabolism and 0.81 for diagnosis of DM. Conclusion Using ADA cutoff values, hemoglobin A1c is not appropriate for postpartum glucose tolerance evaluation in women with recent GDM.

Clinical and metabolic effects of medroxyprogesterone acetate and ethinyl estradiol plus drospirenone in women with polycystic ovary syndrome

Objectives: To investigate the effects of treatment with medroxyprogesterone acetate (MPA), 10 days per month for 6 months, on lipid and carbohydrate metabolism in women with polycystic ovary syndrome (PCOS). Methods: Sixty-three women with PCOS were randomized to receive MPA or ethinyl estradiol plus drospirenone. Results: There were no changes in lipid or carbohydrate metabolism in the MPA group, but serum levels of luteinizing hormone ( P < 0.001) and total testosterone ( P < 0.003) significantly decreased, as did the free androgen index ( P < 0.02) and acne ( P < 0.03) and seborrhea ( P < 0.04) scores. In the ethinyl estradiol plus drospirenone group lipid and hormone values significantly increased whereas acne, seborrhea, hair loss, and Ferriman-Gallwey scores decreased. There was no statistically significant change in the total cholesterol to high-density cholesterol ratio in either group. Conclusion: Treatment of PCOS patients with MPA provided good menstrual cycle control, beneficial changes in hormonal values associated with hyperandrogenism, and no significant changes in lipid or carbohydrate metabolism.

Ethinylestradiol/cyproterone acetate in polycystic ovary syndrome: lipid and carbohydrate changes

Objective Ethinylestradiol (EE) combined with the antiandrogenic progestin cyproterone acetate (CPA) is a possible treatment in polycystic ovary syndrome (PCOS). We investigated the impact of EE/CPA on lipid and carbohydrate metabolism in women with PCOS,who were otherwise healthy. Method The 31 women were separated into two groups paired by body mass index (BMI): Group A (control, n = 15) were cycled with 10 mg medroxyprogesterone acetate (MPA) x 10 days (Provera®, Pharmacia & Upjohn) every month for 3 months; Group B (n = 16) were treated with 35 μg EE/2 mg CPA (Diane 35®, Schering) for 3 months. Metabolic and hormonal conditions were similar in both groups. Results Group A showed no change in any hormone or metabolic parameter. Group B showed a significant decrease in free androgen index (−81%) and increase in sex hormone binding globulin ( + 639%), a decrease in low density lipoprotein cholesterol (−14%) and total cholesterol/high density lipoprotein (HDL) cholesterol index (−19%), and increases in HDL cholesterol ( + 23%) and triglycerides ( + 82%) (p < 0.001). Fasting insulin increased in 18%, the glucose/insulin index worsened in 8%, and the plasma glucose disappearance worsened in 12%, with no statistical significance (p = 0.092, p = 0.308 and p = 0.237, respectively). Conclusion Treatment of PCOS with EE/CPA induces important favorable changes regarding hormone parameters associated with hyperandrogenism, significant favorable changes in lipid profile except for triglyceride increase, and no significant change in carbohydrate metabolism (measured by fasting insulin, glucose/insulin index and plasma glucose disappearance). MPA cycling does not change any of these parameters.

Longitudinal changes in body composition and energy balance in lean women with normal and abnormal glucose tolerance during pregnancy

OBJECTIVE: The objective of this study was to evaluate the longitudinal changes in energy expenditure and body composition in relationship to alterations in carbohydrate metabolism in women with normal and abnormal glucose metabolism. We hypothesized that women with decreased insulin sensitivity before conception would have less fat accretion and smaller increases in energy expenditure. STUDY DESIGN: Six women with normal glucose tolerance and 10 women with abnormal glucose tolerance were evaluated before conception, and in early (12 to 14 weeks) and late (34 to 36 weeks) gestation. Body composition was estimated by hydrodensitometry, resting energy expenditure, and glucose and fat metabolism by indirect calorimetry, endogenous glucose production by infusion of [6-6 2H.. 2] glucose, and insulin sensitivity using a hyperinsulinemic-euglycemic clamp (40 mU/m 2/min). RESULTS: There was a smaller increase in fat mass (1.3 kg [ P = .04]) in early pregnancy in women with abnormal glucose tolerance before pregnancy. Indirect calorimetry measured gestational age–related increases in basal oxygen utilization, with or without correction for fat-free mass (v̇ o 2, P = .002), resting energy expenditure (expressed in kilocalories, P = .0001), and carbohydrate oxidation ( P = .0003). The insulin-mediated elevation in v̇ o 2 increased in later gestation v̇ o 2 ( P = .005), as did resting energy expenditure ( P = .0001) and fat oxidation ( P = 0.0001). However, there was a decrease in respiratory quotient ( P = .0001), carbohydrate oxidation ( P = .002), and nonoxidative carbohydrate metabolism ( P = .0001) with advancing gestation during insulin infusion. In early pregnancy, changes in fat mass correlated inversely with changes in insulin sensitivity ( r = –0.52, P = .04) and changes in basal v̇ o 2 correlated inversely with decreases in basal endogenous glucose production ( r = –0.74, P = .01). CONCLUSION: In early gestation, the changes in maternal fat mass and basal oxygen consumption are inversely related to the changes in insulin sensitivity. This response in lean women with decreased insulin sensitivity before conception may have survival value by providing a larger amount of available substrate to meet fetoplacental needs during gestation. (Am J Obstet Gynecol 1998;179:156-65.)

Influences of weight, body fat patterning and nutrition on the management of PCOS.

Polycystic ovary syndrome (PCOS) is a heterogeneous clinical entity that is defined as the association of hyperandrogenism with chronic anovulation in women without specific underlying diseases of the adrenal or pituitary glands. PCOS is also associated with a metabolic disturbance (insulin resistance). The nature of the complex interrelation of obesity, insulin resistance and endocrine abnormalities in PCOS remains unresolved. However, several studies link obesity, body fat distribution and nutritional habitus with the hormonal and metabolic profiles of PCOS. Moreover, intervention studies have suggested that reducing weight and/or hyperinsulinaemia either by diet alone or by a combination of diet and drugs improves hirsutism, fertility and the hormonal and metabolic profiles of PCOS. In fact, the evaluation of nutritional factors in PCOS is helpful for the screening of metabolic abnormalities and the management of women with PCOS. A point of particular interest in the management of PCOS is that the choice of contraception remains difficult in these high cardiovascular risk women. The impact of pills with ethinyl oestradiol on weight, body fat distribution and carbohydrate metabolism in women with PCOS has not been thoroughly evaluated. The lack of prospective studies to evaluate long-term metabolic and cardiovascular tolerance necessitates care and the assessment of other hormonal possibilities.

Estrogen deprivation, rather than age, is responsible for the poor lipid profile and carbohydrate metabolism in women.

The protective effect of estrogen against cardiovascular diseases (CVD) in women disappears after menopause. However, it is not clear whether the change in risk factors after menopause is related to aging or estrogen deprivation. To assess the risks for CVD and the contribution of aging in estrogen-deprived women. Forty-one patients with premature ovarian failure (POF) (group 1) and 30 patients with natural menopause (group 2) were investigated with respect to well-known risk factors for CVD. Fifteen young women at reproductive age (group 3) were taken as controls. The median ages (ranges) of the groups were 31 (19-40), 52 (46-67) and 26 (24-29) years, respectively. Family and personal history for CVD, smoking, oral contraceptive usage, physical examination, blood pressure measurement, body mass index (BMI), blood level of fasting insulin, diabetes mellitus, and the levels of lipoprotein proteins were the examined parameters regarding the risks for CVD. The levels of triglycerides and very low density lipoprotein (VLDL) cholesterol were not different in the 3 groups. The levels of fasting insulin (11.3 +/- 6.6 vs. 10.2 +/- 5.8 IU/ml), the ratio of fasting insulin to fasting blood glucose (12.2 +/- 6.3% vs. 10.5 +/- 5.4%), high density lipoprotein (HDL) cholesterol (51.9 +/- 12.9 vs. 51.6 +/- 9.7 mg/d), low density lipoprotein (LDL) cholesterol (113 +/- 47 vs. 127 +/- 37 mg/dl) and the ratio of HDL to total cholesterol (27.2 +/- 9.8% vs. 24.1 +/- 6.9%) were not different in women with POF and natural menopause. These parameters were all better in controls with respect to risk for CVD (respectively, 6.5 +/- 2.0 IU/ml, 7.4 +/- 2.2%, 37.9 +/- 5.3 mg/dl, 80 +/- 40 mg/dl, P < 0.05). Risk factors for CVD are related to estrogen deprivation. Aging does not have an important impact on CVD within the age range of this study group.

Thiazide-Associated Metabolic Abnormalities and Estrogen Replacement Therapy

The objective of this study was to identify abnormalities in lipid and carbohydrate metabolism in women taking thiazide diuretics and determine whether these abnormalities are mitigated by concurrent postmenopausal estrogen replacement therapy. The study design was cross-sectional; its setting was Rancho Bernardo, an upper middle-class community in southern California. The subjects included 1047 white nondiabetic postmenopausal women, aged 50-89 yr, categorized by the use of thiazide diuretic, estrogen replacement therapy, both, or neither. Medical history including behavior, verified medication use, height, weight, fasting chemistry and lipid panels, and a standardized oral glucose tolerance test with fasting and 2-h plasma glucose and serum insulin levels were determined. Compared with nonusers, women taking thiazides had significantly lower high density lipoprotein cholesterol levels and significantly higher fasting triglyceride, glucose, and insulin levels. Concomitant use of thiazide and estrogen yie...

Thiazide-associated metabolic abnormalities and estrogen replacement therapy: an epidemiological analysis of postmenopausal women in Rancho Bernardo, California.

The objective of this study was to identify abnormalities in lipid and carbohydrate metabolism in women taking thiazide diuretics and determine whether these abnormalities are mitigated by concurrent postmenopausal estrogen replacement therapy. The study design was cross-sectional; its setting was Rancho Bernardo, an upper middle-class community in southern California. The subjects included 1047 white nondiabetic postmenopausal women, aged 50-89 yr, categorized by the use of thiazide diuretic, estrogen replacement therapy, both, or neither. Medical history including behavior, verified medication use, height, weight, fasting chemistry and lipid panels, and a standardized oral glucose tolerance test with fasting and 2-h plasma glucose and serum insulin levels were determined. Compared with nonusers, women taking thiazides had significantly lower high density lipoprotein cholesterol levels and significantly higher fasting triglyceride, glucose, and insulin levels. Concomitant use of thiazide and estrogen yielded lipid profiles and fasting glucose and insulin levels similar to those of subjects receiving estrogen alone, i.e. elevated high density lipoproteins, decreased low density lipoproteins, and lower levels of fasting glucose and insulin compared with those in nonusers. However, thiazide-associated postchallenge glucose and insulin elevations were not modified by estrogen. These patterns were not explained by differences in age, body mass index, exercise, smoking, alcohol use, type or dose of thiazide diuretic, type of estrogen replacement, or serum potassium levels. We conclude that postmenopausal estrogen use masks thiazide-associated dyslipidemia and fasting elevations in glucose and insulin levels, but does not improve thiazide-associated postchallenge glucose intolerance and hyperinsulinemia. Modification of most of the untoward metabolic effects of thiazides in women taking postmenopausal estrogen could provide a new incentive for the use of this traditional antihypertensive in elderly women.

Carbohydrate metabolic studies during twelve months of treatment with a low-dose combination oral contraceptive

Carbohydrate metabolism was evaluated in twenty healthy women volunteers using a low-dose combination oral contraceptive (OC) containing 30 μg of ethinyl estradiol and 500 μg of dl-norgestrel by measurement of serum glucose and insulin levels during 3-hour oral glucose tolerance test (OGTT) before and after 3, 6 and 12 months of medication. There were no significant differences in body weight or blood pressure between pretreatment and posttreatment. Fasting serum glucose levels were slightly reduced, though not significantly, during all periods of treatment. But serum glucose levels were increased at 1, 2 and 3 hours in association with high insulin responses during OGTT in all periods of OC therapy, indicating mild to moderate insulin resistance. These data suggest that the low-dose combination OC used in the study exerts alterations on carbohydrate metabolism in women during one year of OC use.

The effects of two triphasic oral contraceptives on carbohydrate metabolism in women during 1 year of use

Sixty-one women were randomly assigned to use one of two different triphasic oral contraceptives (OCs), for one year's time (Ortho Novum 777, Ortho Pharmaceutical Corp., Raritan, NJ, and Triphasil, Wyeth Laboratories, Philadelphia, PA), containing the progestins norethindrone and levonorgestrel, respectively. The carbohydrate metabolism was evaluated using the oral glucose tolerance test before OC use and at the end of the 12th month. Both plasma glucose and insulin levels were measured. The fasting glucose value in the norethindrone-containing OC group (777) was significantly lower at the 1-year testing. All other values were unchanged. These data demonstrate that the triphasic oral contraceptive preparations currently in use have minimal effects on carbohydrate metabolism.