title: Divergent effects of a combined hormonal oral contraceptive on insulin sensitivity in lean versus obese women.
abstract: OBJECTIVE
  To evaluate the effects of a commonly used combined hormonal oral contraceptive (OC) on carbohydrate metabolism in obese as compared with lean women.
  
  
  METHODS
  6-month prospective study.
  
  
  METHODS
  Clinical research center at an academic medical center.
  
  
  METHODS
  Premenopausal nondiabetic women with body mass index <25 kg/m(2) (n = 15) or >30 kg/m(2) (n = 14).
  
  
  METHODS
  Ethinyl estradiol (35 μg) and norgestimate (0.18/0.215/0.25 mg) for 6 cycles.
  
  
  METHODS
  Insulin sensitivity by frequent sampling intravenous glucose tolerance test; other indices of insulin sensitivity (homeostatic model assessment of insulin sensitivity index [ISI HOMA], the Matsuda index); fasting lipid panel.
  
  
  RESULTS
  Insulin sensitivity changed from 6.62 ± 3.69 min(-1)/mIU/L (baseline) to 8.23 ± 3.30 min(-1)/mIU/L (6 months) in lean women, and from 4.36 ± 2.32 to 3.82 ± 2.32 min(-1)/mIU/L in obese women. Divergent effects on insulin sensitivity were also observed with ISI HOMA and the Matsuda index. Low-density lipoprotein increased by approximately 20 mg/dL in both the lean and obese groups.
  
  
  CONCLUSIONS
  Lean and obese women exhibit differential changes in insulin sensitivity when given 6 months of a commonly used oral contraceptive. The mechanisms of these differences and whether these divergent effects persist in the long term require further investigation.
authors.affiliation: Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA. kicheang@vcu.edu
authors.forename: Kai I
authors.initials: KI
authors.lastname: Cheang
authors.forename: Paulina A
authors.initials: PA
authors.lastname: Essah
authors.forename: Susmeeta
authors.initials: S
authors.lastname: Sharma
authors.forename: Edmond P
authors.initials: EP
authors.lastname: Wickham
authors.forename: John E
authors.initials: JE
authors.lastname: Nestler
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage*; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004997:Ethinyl Estradiol / Q000008:administration & dosage*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D008077:Lipoproteins, LDL / Q000097:blood; D009644:Norgestrel / Q000008:administration & dosage / Q000031:analogs & derivatives*; D009765:Obesity / Q000378:metabolism* / Q000503:physiopathology; D011446:Prospective Studies; D013851:Thinness / Q000378:metabolism* / Q000503:physiopathology; D013997:Time Factors; D014768:Virginia; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D004338:Drug Combinations; D007328:Insulin; D008077:Lipoproteins, LDL; C109079:norgestimate, ethinyl estradiol drug combination; D009644:Norgestrel; D004997:Ethinyl Estradiol