 |
|
Diabetes and Depot Medroxyprogesterone Contraception in Navajo Women
Catherine Kim, MD, MPH;
Keith W. Seidel, MD;
Elizabeth A. Begier, MD;
Yeong S. Kwok, MD
Arch Intern Med. 2001;161:1766-1771.
Background Depot medroxyprogesterone acetate contraception is widely used in Navajo
women, a high-risk population for diabetes mellitus. However, depot medroxyprogesterone
may lead to weight gain and independently decrease insulin sensitivity. We
studied the association between depot medroxyprogesterone and development
of diabetes in Navajo women.
Methods We studied Navajo women aged 18 to 50 years who had seen a health care
provider at a Navajo Area Indian Health Service clinic at least once in 1998.
Diabetic cases (n = 284) and nondiabetic controls (n = 570) were matched by
age. Medical records were reviewed to determine contraception use before the
diagnosis date of diabetes.
Results Users of depot medroxyprogesterone were more likely to develop diabetes
than patients who had used combination estrogen-progestin oral contraception
only (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.8-7.9). The excess
risk persisted after adjustment for body mass index (OR, 3.6; 95% CI, 1.6-7.9).
Longer use was associated with greater risk of diabetes. Users of depot medroxyprogesterone
were also more likely to develop diabetes than patients who had never used
hormonal contraception, although excess risk was smaller (OR, 2.4; 95% CI,
1.4-3.6).
Conclusions Depot medroxyprogesterone contraception was associated with a greater
risk of diabetes compared with combination oral contraceptive use only. Risk
was associated with length of use and persisted after adjustment for body
mass index. Additional research is needed for confirmation, but this risk
should be considered in contraceptive choice for women at high risk for diabetes.
From the Robert Wood Johnson Clinical Scholars Program (Dr Kim) and
Department of Medicine (Dr Kwok), University of Washington, Seattle; and Crownpoint
Healthcare Facility, Crownpoint, NM (Drs Seidel and Begier).
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2001;161(14):1783-1784.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Contraception After Gestational Diabetes
Damm et al.
Diabetes Care 2007;30:S236-S241.
FULL TEXT
Long-acting injectable progestin contraception and risk of type 2 diabetes in latino women with prior gestational diabetes mellitus.
Xiang et al.
Diabetes Care 2006;29:613-617.
ABSTRACT
| FULL TEXT
Decline in Lung Function in Patients With Lymphangioleiomyomatosis Treated With or Without Progesterone
Taveira-DaSilva et al.
Chest 2004;126:1867-1874.
ABSTRACT
| FULL TEXT
Effects of Injectable or Implantable Progestin-Only Contraceptives on Insulin-Glucose Metabolism and Diabetes Risk
Kahn et al.
Diabetes Care 2003;26:216-225.
ABSTRACT
| FULL TEXT
|
