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Effect of a Levonorgestrel Intrauterine System on Women With Type 1 Diabetes: A Randomized Trial

Svetlana Rogovskaya, MD, PhD^*, Roberto Rivera, MD, David A. Grimes, MD, Pai-Lien Chen, PhD, Bosny Pierre-Louis, MPH^*, Vera Prilepskaya, MD, PhD^* and Vladimir Kulakov, MD, PhD^*

From the *Research Center of Obstetrics, Gynecology, and Perinatology, Russian Academy of Medical Science, Moscow, Russia; and Family Health International, Research Triangle Park, North Carolina.

OBJECTIVE: Women with diabetes need safe, effective contraception. Although intrauterine devices provide superior contraception, concerns remain that progestin absorbed systemically from the levonorgestrel-releasing device may impair carbohydrate metabolism. To examine the effect of the levonorgestrel-releasing intrauterine system on glucose metabolism in diabetic women.

METHODS: We randomly assigned 62 women with uncomplicated insulin-dependent diabetes mellitus to either a levonorgestrel-releasing or a copper T 380A intrauterine device. The primary outcome to assess glucose metabolism was glycosylated hemoglobin; fasting serum-glucose levels and daily insulin dose requirements over 12 months of observation were examined as well.

RESULTS: Outcome data were available for 29 women using the levonorgestrel-releasing and 30 using the copper device. At 12 months, mean glycosylated levels were similar for women of the 2 groups (6.3%, standard deviation [SD] ± 1.5 compared with 6.3%, SD ± 1.3, respectively). The same was true for mean fasting-serum glucose levels (7.4 mM, SD ± 4.2 compared with 7.5 mM, SD ± 4.2) and daily insulin doses (35.1 units, SD ± 12.8 compared with 36.4 units, SD ± 9.0). No important differences were noted at either 6 weeks or 6 months.

CONCLUSION: The levonorgestrel-releasing device had no adverse effect on glucose metabolism, even at the 6-week observation when systemic levels of levonorgestrel would have been higher than at later observations. Concern about a potential adverse effect of this contraceptive on glucose control is unwarranted, and its use in women with diabetes should be liberalized.

LEVEL OF EVIDENCE: I

This article has been cited by other articles:

				P. Damm, E. R. Mathiesen, K. R. Petersen, and S. Kjos Contraception After Gestational Diabetes Diabetes Care, July 1, 2007; 30(Supplement_2): S236 - S241. [Full Text] [PDF]

				Levonorgestrel IUDs Don't Affect Diabetes Journal Watch (General), April 19, 2005; 2005(419): 5 - 5. [Full Text]