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

Autor: Melhado-Kimura V; Family Planning Clinic, Department of Obstetrics and Gynecology, University of Campinas Medical School, 13084-971, Campinas, SP, Brazil., Batista GA; Department of Clinical Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil., de Souza AL; Department of Clinical Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil., Silva Dos Santos PN; Family Planning Clinic, Department of Obstetrics and Gynecology, University of Campinas Medical School, 13084-971, Campinas, SP, Brazil., Alegre SM; Department of Clinical Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil., Pavin EJ; Department of Clinical Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil., Bahamondes L; Family Planning Clinic, Department of Obstetrics and Gynecology, University of Campinas Medical School, 13084-971, Campinas, SP, Brazil., Fernandes A; Family Planning Clinic, Department of Obstetrics and Gynecology, University of Campinas Medical School, 13084-971, Campinas, SP, Brazil. Electronic address: arlete@fcm.unicamp.br.
Jazyk: angličtina
Zdroj: Contraception [Contraception] 2018 Apr 14. Date of Electronic Publication: 2018 Apr 14.
DOI: 10.1016/j.contraception.2018.04.003
Abstrakt: 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, LDL-cholesterol, 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.
(Copyright © 2018. Published by Elsevier Inc.)
Databáze: MEDLINE
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