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Effect of Depot Medroxyprogesterone Acetate on Glucose Tolerance in Generalized Lipodystrophy

From the ¹Combined Federal Fellowship in Reproductive Endocrinology and Infertility at National Institutes of Health (NIH), Walter Reed Army Medical Center, National Naval Medical Center, and Uniformed Services University of the Health Sciences, Bethesda, Maryland; ²Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, Maryland; ³Division of Reproductive Endocrinology and Infertility, Walter Reed Army Medical Center, Washington, DC; and ⁴Clinical Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, Maryland.

ABSTRACT

BACKGROUND: Lipodystrophy is a rare condition causing severe insulin resistance and frank diabetes. Depot medroxyprogesterone acetate (DMPA), a commonly used contraceptive, may worsen glucose tolerance in diabetics and those with lipodystrophy.

CASE: A young woman with generalized lipodystrophy, who previously required greater than 1,000 units of insulin daily, had a normal hemoglobin A1c on leptin and metformin only. After an injection of DMPA, she developed severe hyperglycemia. Her levels returned to near normal only with extremely high doses of insulin (up to 1,700 units/d) and increased doses of leptin and metformin.

CONCLUSION: Progestin-only contraceptives may detrimentally affect glucose tolerance, particularly in patients with lipodystrophy, a cause of severe insulin resistance and leptin deficiency. One DMPA injection appeared to profoundly alter glucose metabolism in this patient with frank diabetes resulting from lipodystrophy. The effect of progestin-only contraceptives on glucose tolerance should be monitored closely in any diabetic patient.