Hyperinsulinemic-euglycemic clamp over the first year of use of depot-medroxyprogesterone acetate as a contraceptive

Author(s)

Melhado-Kimura, Vaneska ^[1] ; Batista, Gisele Almeida ^[2] ; de Souza, Aglecio Luiz ^[2] ; Silva dos Santos, Priscilla de Nazare ^[1] ; Alegre, Sarah Monte ^[2] ; Pavin, Elizabeth Joao ^[2] ; Bahamondes, Luis ^[1] ; Fernandes, Arlete ^[1]

Affiliation

^[1] Univ Estadual Campinas, Med Sch, Dept Obstet & Gynecol, Family Planning Clin, BR-13084971 Campinas, SP - Brazil

^[2] Univ Estadual Campinas, UNICAMP, Sch Med Sci, Dept Clin Med, Campinas, SP - Brazil

• Document type: Journal article
• Source: Contraception; v. 98, n. 2, p. 144-150, AUG 2018.
• Web of Science Citations: 1

Abstract

Objective: The literature lacks data on the use of the gold-standard hyperinsulinemic-euglycemic clamp (HEC) technique for the evaluation of insulin resistance (IR) in depot-medroxyprogesterone acetate (DMPA) users. This study assessed carbohydrate metabolism in non-obese users of DMPA using the HEC technique. Study Design: A prospective, non-randomized, comparative study conducted at the Family Planning Clinic/Metabolic Unit, University of Campinas, Brazil. Forty-eight women aged 18-39 years underwent HEC: 30 initiating use of DMPA and 18 initiating use of a copper intrauterine device (IUD). Data from 15 women in each group, who completed the follow-up and underwent HEC at12 months, were compared using repeated measures ANOVA. All women were advised to perform aerobic physical exercise for 150 min/week; body composition and total energy intake were evaluated. Main outcome measures were IR defined by M-value <4 mg/kg/min, and blood levels of insulin. Additional outcomes were total cholesterol, HDL-cholesterol, triglycerides, LDLcholesterol, adipokines and free fatty acids. Results: At 12 months, two women in the DMPA group and none in the IUD group had developed IR. The groups were similar in in M-values and in blood levels of insulin, total cholesterol, HDL-cholesterol, LDL-cholesterol, adipokines or free fatty acids. Triglyceride levels increased in the DMPA group when compared to the IUD group, 80.0 (SD 47.8) versus 61.8 (SD 35.8) mg/dL respectively, (p=.033); and increased the total daily energy intake, 1828.3 (SD 518.9) versus 1300.8 (SD 403.4) kilocalories/24hs, respectively in the same groups, (p=.041). All the DMPA users showing higher insulin sensitivity at 12 months reported performing physical activity regularly. Conclusions: Changes occurred in carbohydrate metabolism in DMPA users in the first year of use of the method. It is possible that the regular aerobic exercise may exert a beneficial and protective effect against the factors that trigger these changes. Implications statement: Carbohydrate metabolism undergoes adverse changes in few young non-obese women during the first year of DMPA use and regular aerobic exercise may exert a beneficial and protective effect against these changes. (C) 2018 Published by Elsevier Inc. (AU)

• FAPESP's process: 09/53293-0 - Prospective study for evaluation of the insulin resistance, lipid metabolism and sub clinical cardiovascular disease in women who initiate the depot-medroxyprogesterone acetate (DMP A) contraceptive method with in follow-up for two years. (Project of scientific research)
• Grantee: Luis Guillermo Bahamondes
• Support Opportunities: Research Grants - Research in Public Policies for the National Health Care System (PP-SUS)