Effect of a levonorgestrel intrauterine system on women with type 1 diabetes: a randomized trial.
OBJECTIVE
Women with diabetes need safe, effective contraception. Although intrauterine devices provide superior contraception, concerns remain that progestin absorbed systemically from the levonorgestrel-releasing device may impair carbohydrate metabolism. To examine the effect of the levonorgestrel-releasing intrauterine system on glucose metabolism in diabetic women.


METHODS
We randomly assigned 62 women with uncomplicated insulin-dependent diabetes mellitus to either a levonorgestrel-releasing or a copper T 380A intrauterine device. The primary outcome to assess glucose metabolism was glycosylated hemoglobin; fasting serum-glucose levels and daily insulin dose requirements over 12 months of observation were examined as well.


RESULTS
Outcome data were available for 29 women using the levonorgestrel-releasing and 30 using the copper device. At 12 months, mean glycosylated levels were similar for women of the 2 groups (6.3%, standard deviation [SD] +/- 1.5 compared with 6.3%, SD +/- 1.3, respectively). The same was true for mean fasting-serum glucose levels (7.4 mM, SD +/- 4.2 compared with 7.5 mM, SD +/- 4.2) and daily insulin doses (35.1 units, SD +/- 12.8 compared with 36.4 units, SD +/- 9.0). No important differences were noted at either 6 weeks or 6 months.


CONCLUSIONS
The levonorgestrel-releasing device had no adverse effect on glucose metabolism, even at the 6-week observation when systemic levels of levonorgestrel would have been higher than at later observations. Concern about a potential adverse effect of this contraceptive on glucose control is unwarranted, and its use in women with diabetes should be liberalized.


METHODS
I.
Rogovskaya
Svetlana
S
Research Center of Obstetrics, Gynecology, and Perinatology, Russian Academy of Medical Science, Moscow, Russia. srogovskaya@freemail.ru
Rivera
Roberto
R
Grimes
David A
DA
Chen
Pai-Lien
PL
Pierre-Louis
Bosny
B
Prilepskaya
Vera
V
Kulakov
Vladimir
V
D000328:Adult; D001786:Blood Glucose / Q000187:drug effects*; D003922:Diabetes Mellitus, Type 1; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D007435:Intrauterine Devices, Copper; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000494:pharmacology*; D016896:Treatment Outcome
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D016912:Levonorgestrel