Insulin resistance parameters in users of the injectable contraceptive depot medroxyprogesterone acetate during one year of use

Abstract

Objectives The aim of the study was to assess insulin resistance parameters using successive homeostasis model assessment (HOMA) and clinical evaluations in healthy new users of depot medroxyprogesterone acetate (DMPA).

Methods A prospective 12-month study was carried out to compare 31 DMPA users with 25 copper intrauterine device (Cu-IUD; TCu380A) users, matched for age (± 1 year) and body mass index (BMI; ± 1 kg/m²). Participants met the following criteria: age 18 to 40 years, BMI < 30 kg/m², fasting glucose < 5.5 mmol/l, 2-h glucose after a 75 g oral glucose load < 140 mg/dl. BMI, waist circumference, fasting glucose, fasting insulin and HOMA of insulin resistance (HOMA-IR) were evaluated at baseline and after 6 and 12 months of contraceptive use. Insulin resistance was defined as a HOMA-IR value > 2.7.

Results The DMPA group showed significant increases in BMI, waist circumference, fasting insulin and HOMA-IR throughout the observation period in relation to baseline. Significant increases in BMI and waist circumference were observed in the DMPA group at 12 months compared with the Cu-IUD group. Five DMPA users had abnormal HOMA-IR values, three of whom had gained > 5 kg in weight at 12 months.

Conclusions HOMA-IR represents a useful tool to indicate changes in carbohydrate metabolism in non-obese DMPA users, especially when accompanied by measurement of clinical parameters such as BMI and waist circumference.

Abstract

摘要

目的 本研究的目的是应用胰岛素抵抗——稳态模型评估系统（HOMA-IR）以及临床参数评估健康妇女初次使用醋酸甲羟孕酮避孕针（DMPA）一年的胰岛素抵抗情况。

方法 采用前瞻性研究方法，比较31名使用DMPA以及25名使用含铜的宫内节育器（Cu-IUD,TCu380A）的妇女使用1年后胰岛素抵抗有关各项参数的变化，按照年龄（±1岁）以及体重指数（BMI; ±1kg/m²）进行配对。入选标准为：年龄在18-40岁之间， BMI＜30kg/m²,，空腹血糖＜5.5mmol/L，75克糖耐量实验2小时血糖＜140mg/dL。在基线、入选后6个月以及12个月均进行BMI、腰围、空腹血糖，空腹胰岛素的测定及胰岛素抵抗稳态模型评估。HOMA-IR测定值＞2.7为异常，定义为胰岛素抵抗。

结果 DMPA组在使用过程中，与基线进行比较，其BMI、腰围、空腹胰岛素以及HOMA-IR值均有显著地增加。在使用的第12个月，DMPA组的BMI以及腰围与Cu-IUD组比较，均有显著地增加。5名使用DMPA的妇女出现了异常的HOMA-IR值，其中3名妇女在这12个月中体重增加超过5kg。

结论 对于评估非肥胖DMPA使用者的碳水化合物代谢改变，HOMA-IR系统是一项非常有用的工具，尤其是在与BMI 或腰围等临床参数配合使用的时候。

Keywords:

• Contraception
• Depot medroxyprogesterone acetate
• HOMA index
• Insulin resistance

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper

This study was funded by the Brazilian National Research Council (CNPq) and by the Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP), Secretaria de Estado da Saúde de São Paulo (SES-SP) grant PPSUS/2009, #2009/53293-0, Brazil.