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  • Title: [Oral contraception and carbohydrate metabolism: III--practical implications].
    Author: Hilal M.
    Journal: Contracept Fertil Sex (Paris); 1986 Jan; 14(1):59-62. PubMed ID: 12341242.
    Abstract:
    Effects of oral contraceptives (OCs) on glucose metabolism can be considered on 2 levels: production of diabetes or impaired glucose tolerance, and production or aggravation of vascular complications caused by chronic hyperglycemia. Combined OCs can promote development of diabetes in predisposed women. The frequency of impaired glucose tolerance increases and the reversibility of the condition decreases with duration of use. Subjects with impaired glucose tolerance are known to have much higher eventual rates of diabetes than normal subjects. It can be concluded that OC usage in the long run can indirectly increase the incidence of diabetes. It is now accepted that diabetic microangiopathy is related to the degree and duration of hyperglycemia, although a genetic component appears to determine its severity. The possibility that OCs thicken the basal membranes of capillaries, an index of diabetic microangiopathy, cannot be formally ruled out. On the macroangiopathic level, OCs considerably increase the incidence of cardiovascular maladies. The relative risk of death for all cardiovascular diseases taken together is tripled in OC users. The excess mortality is related primarily to increased incidence of myocardial infarcts, cerebral vascular accidents, and pulmonary emboli. 2 kinds of vascular accidents are related to pill use: early venous or arterial accidents of poorly elucidated physiopathology, and arterial accidents after longer use which recall the classic atherosclerotic factors related to chronic hyperglycemia. A study by Whitehall of 18,403 subjects indicated that even slight deterioration of glucose tolerance caused by pills might aggravate vascular risks. All pills produce a state of chronic hyperinsulinemia. Chronic hyperinsulinemia has been incriminated as an atherosclerotic risk factor because of its effects on the arterial walls, including proliferation of smooth muscle fibers and development of fat-filled lesions similar to those of early atherosclerosis. Atherosclerosis is multifactorial, and OCs aggravate most of the factors. Pill-induced hypertension is associated with more serious deterioration of glucose tolerance and more severe hyperlipidemia. Few epidemiologic studies have examined the vascular risks of OCs in a population of diabetic women, but 1 study of 120 insulin-dependent diabetic women using OCs and 136 insulin dependent nonusers found 4 vascular accidents in users under 30 years old and none in nonusers. Deterioration of glucose tolerance in normal women using OCs should be regarded as a sign of increased vascular risk. Glucose tolerance should be determined for all women prior to OC prescription. OCs in any form are contraindicated in cases of a history of gestational diabetes or of diabetes or impaired glucose tolerance appearing with pill use and disappearing on termination of use; in cases of impaired glucose tolerance with a familial or obstetric history of diabetes; and of diabetes or impaired glucose tolerance complicated with angiopathy. Relative contraindications to OC use include diabetes and impaired glucose tolerance in cases where angiopathy is absent. Low-dose pregestin pills may be used in such cases. Effective contraception is necessary for diabetic women. The IUD may be used in well controlled diabetics with careful surveillance for infection.
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