[Oral contraceptives and diabetes mellitus]. / P-piller og diabetes mellitus.

ABSTRACT

PIP The author reviews studies on the adverse effects of oral contraceptives (OCs) on insulin response and blood lipids in diabetes mellitus. The mechanisms of OCs and their diabetogenic effects are not well understood. The effect is dose-dependent on the estrogen and progestin content of the individual pill. Low doses of the new triphasic preparations appear to have a minimal effect on carbohydrate and lipid metabolism. Disorders of diabetic metabolism in insulin-dependent diabetics and a possible deterioration of noninsulin-dependent diabetics or potential diabetics have been attributed to earlier types of contraceptive pills with a higher steroid content. Whether the adverse effects can be avoided by taking low-dose or triphasic contraceptive preparations is yet unknown. In a recent study 120 patients, 3 women suffered temporary cerebral thrombosis and one a myocardial infarction. A comparative study found no cardiovascular complications in a control group of 156 insulin-dependent diabetics who were not on contraceptives. Whether contraceptives have an effect on existing diabetic retinopathy is not yet known. Since diabetic women already have a higher risk of cardiovascular complications, women who had diabetes in pregnancy should undergo a glucose tolerance test once a year while on contraceptives. It is very important to find a safe contraceptive method for diabetics. At the present time mini-pills or IUDs seem to have the fewest side effects.^ieng