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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ethinyl estradiol is the only estrogen form used in low-dose oral contraceptive (OC) pills. Progestogenic compounds used in OCs include norethindrone, norethindrone acetate, ethynodiol diacetate, norgestrel, levonorgestrel, and norethynodrel. The newest third generation progestins are desogestrel and norgestimate. The most important benefits associated with OC use are a decrease in benign breast disease, less incidence of ovarian and endometrial cancers, and a decrease in the incidence of pelvic inflammatory disease. The most serious risks to OC users who are over age 35 and smoke are deep vein thrombosis, pulmonary embolus, retinal thrombosis, or cardiovascular disease. Other risk factors for cardiovascular disease include obesity, diabetes, hypertension, increased serum cholesterol, and a family history of premature myocardial infarction. All users should have blood pressure checks 3 and 6 months after commencing pill use. OC preparations cause an increase in total cholesterol, triglycerides, low density lipoprotein (LDL), very low density lipoprotein (VLDL), and a decrease in high density lipoprotein (HDL), but norgestimate may actually increase HDL levels. Preparations with levonorgestrel may produce the greatest decrease in glucose tolerance, while those with 35 mcg of ethinyl estradiol and 0.5 mg of norethindrone have the least effect. OCs do not increase the risk of developing breast cancer, but can stimulate the growth of breast cancer once it has occurred. The incidence of gallbladder disease is increased slightly in OC using women who are predisposed. Hepatocellular adenomas are associated with combined OC use. Underweight women are more prone to side effects and need a very low potency preparation. A common problem encountered by patients on OCs is amenorrhea. This usually resolves after 3 cycles. Breakthrough bleeding is also very common. Post-pill amenorrhea is frequently found after stopping OCs. Combined oral contraceptives are a safe and effective contraceptive method for most women throughout their reproductive years.
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PMID:Combined oral contraceptive pills: a brief review. 783 35

The effects of contraceptive steroids on the expression of endothelial homeostasis were examined by direct and indirect measures in women with insulin-dependent diabetes mellitus (IDDM) in a prospective nonrandomized controlled study. Study subjects were 13 women with uncomplicated IDDM treated with a monophasic combination of 30 micrograms ethinyl estradiol and 75 micrograms gestodene for 12 consecutive cycles and 13 women of comparable diabetic status as control. During the study period, none of the participants developed increased renal albumin excretion, which was used as a direct measure of endothelial function. In the indirect assessment of endothelial function, we found a proportionate increase in plasma levels of thrombin-antithrombin III (TAT) complexes and D-dimer during treatment. Hormonal intake was followed by decreased antigen concentrations of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (type 1 [PAI-1]), whereas the activities of t-PA and PAI-1 were unchanged. Plasma levels of plasminogen and histidine-rich glycoprotein (HRG) increased and decreased, respectively, whereas an increase in von Willebrand factor was observed in the treatment group. No significant changes in direct or indirect measures were observed in the control group during the observation period of 12 months. In conclusion, no adverse effect on endothelial function was demonstrated by direct measures, but our findings suggest that a procoagulant state, compensated by enhanced activity of the fibrinolytic system, is induced by hormonal treatment. Clinical and metabolic monitoring is recommended if the use of oral contraceptives in women with IDDM is extended.
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PMID:Assessment of endothelial function during oral contraception in women with insulin-dependent diabetes mellitus. 796 93

Estrogen and progestogen effects on lipid and carbohydrate metabolism are reviewed. Their actions depend on the type and dosage of molecules and their route of administration. Steroid replacement therapy in post menopausal women results in most cases in beneficial effect on lipids without alteration of carbohydrate metabolism. Therapeutic implications in women with metabolic disturbances as hyperlipidemia or diabetes are discussed.
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PMID:[Estrogens, progestins and glucido-lipid metabolism]. 814 62

Prescribing contraceptives to diabetic women requires cognizance of metabolic effects and the risks of type I or type II and gestational diabetes mellitus (GDM) in prediabetic women. Studies have show that poor maternal glycemic control in the 1st trimester in diabetic women has resulted in a twofold to threefold increased risk for congenital malformations. A reduction from 6.6% to 1.1% in malformations could be realized by euglycemic control before conception and during the first 8 weeks of gestation. A low-estrogen preparation should be selected and blood pressure should be monitored regularly. Progestins adversely affect carbohydrate and lipid metabolism, as they decrease glucose tolerance by increased insulin resistance, thus the selection of proper progestin dose/potency is important in prescribing OCs. The lowest-dose OCs may be prescribed under close medical supervision to women with insulin-dependent diabetes mellitus (IDDM) without serious vascular complications. Patients should be evaluated after the 1st cycle of OC use and every 3-4 months thereafter with monitoring of weight, blood pressure, postprandial glucose, and glycosylated hemoglobin levels. Women with prior GDM should be evaluated annually utilizing a 2-hour, 75-g glucose tolerance test (OGTT) at the postpartum visit. For OCs, a low-dose estrogen ( 0.05 mg ethinyl estradiol) and a low-dose/potency progestin (or = 0.50 mg of norethindrone or or= 0.100 mg of levonorgestrel) should be selected. The safety of prescription of OCs to women with type II diabetes is unclear, but a supervised program similar to that of IDDM patients is recommended. Currently neither of the long-term contraceptives, depo-medroxy-progesterone acetate (Depo-Provera) injection or the levonorgestrel-containing implant, Norplant, are recommended as first-time methods for women with diabetes. On the other hand, the IUD is an effective, reversible method, particularly for older women with hypertension, provided antibiotic prophylaxis is undertaken at the time of insertion.
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PMID:Contraception in the diabetic woman. 822 75

A monophasic oral contraceptive (OC) containing 30 mcg ethinyl estradiol and 150 mcg desogestrel is the most commonly used OC in Europe. Desogestrel alone inhibits ovulation at 60 mcg/day. Breakthrough bleeding occurs in about 2.5% of all cycles. Intermenstrual bleeding occurs in about 8% of cycles. It is most common in cycle 1 and then decreases with subsequent cycles. Few women using this combined OC discontinue because of bleeding problems. Desogestrel's low androgenicity accounts for low incidences of acne and hirsutism. The combined OC causes few minor side effects. It appears to increase high density lipoprotein-cholesterol levels and to decrease low density lipoprotein-cholesterol levels. Even though various monophasic OCs significantly increase the area under the curve (AUC) for glucose, insulin, and C-peptide, the desogestrel-OC was the least active for glucose at 50% and one of the two lowest for insulin (20%) and C-peptide (16%). The increased AUCs signify a moderate slowed response to glucose loading and increased insulin resistance, rather than a diabetes-like situation. The trends in values for fibrinolytic activity and for fibrinogen suggest that the desogestrel-OC activates the clotting system, but European studies show that the clotting behavior activated by the desogestrel-OC is no different than that activated by a gestodene-monophasic OC. Desogestrel has a long half-life (23.8 hours) which prolongs the period during which women who miss 1-2 pills can be protected from pregnancy. In conclusion, the desogestrel-OC provides reliable contraception and good cycle control. It causes few side effects, a positive overall effect on lipid metabolism, and minimal effects on carbohydrate metabolism and hemostasis.
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PMID:Clinical review of a monophasic oral contraceptive containing desogestrel and ethinyl estradiol. 826 Sep 69

The effects of streptozotocin-induced (STZ) diabetes on the negative feedback regulation of LH and FSH were evaluated in adult female rats. Rats were injected with STZ (50 mg/kg) or vehicle and ovariectomized 10 days later. Estrogen (EB; 100 micrograms/kg) or oil injections were given on alternate days, starting on the day of ovariectomy. Blood samples for LH, FSH and PRL assay were taken on days 10, 13, 15 and 17. The rats were decapitated on day 17. One hour prior to sacrifice, one half of the animals were injected with alpha-methyl-p-tyrosine for determination of catecholamine turnover rates. Pituitaries were incubated to determine basal secretion rates. Rats treated with STZ exhibited the expected weight loss and elevation of plasma glucose levels. At the time of ovariectomy, FSH, but not LH or PRL, was depressed in the diabetic rats. The postovariectomy rise in LH and FSH was severely attenuated in the diabetic rats. EB treatment was more effective in lowering LH and FSH levels in the diabetic as compared to the control rats. Median eminence (ME) norepinephrine (NE) and dopamine (DA) turnover was higher in the oil-treated diabetic rats than oil-treated controls. EB also caused a greater decrease in ME NE and DA turnover in the diabetic rats. EB was more effective in decreasing in vitro LH secretion and increasing in vitro PRL secretion from pituitaries of control as compared to STZ-treated animals. These results demonstrated that STZ-induced diabetes leads to an attenuation of LH and FSH release after ovariectomy and potentiates the negative feedback effects of EB.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of streptozotocin-induced diabetes on neuroendocrine responses to ovariectomy and estrogen replacement in female rats. 832 21

Oral contraceptives (OCs) were first introduced more than 30 years ago. OC manufacturers have reduced the dosage of synthetic estrogens (e.g., ethinyl estradiol, 100-150 mcg to 20-35 mcg) and progestins to limit their metabolic effects on lipoproteins, carbohydrates, and hemostasis. In addition to protection from pregnancy, OC benefits include lower incidence of painful periods, excessive bleeding, and iron deficiency anemia; reduction of ovarian cysts, benign breast tumors, and pelvic inflammatory disease; and protection against endometrial and ovarian cancers. The risk of a cardiovascular event (myocardial infarction, cerebrovascular events, venous thromboembolism, and deep vein thrombophlebitis) in OC users is 1-2/100,000 women years. Cardiovascular risk factors include smoking, hypertension, lipid disorders, severe obesity, diabetes mellitus, and cardiovascular events in first degree relatives before age 40. Thus, women with any of these risk factors should not use OCs. OCs do not increase the risk of breast cancer in women less than 59 years old. They may increase this risk if used over a long duration before the first fullterm pregnancy. OCs may cause a modest increase in cervical neoplasia. Low-dose OCs have a small effect on lipid metabolism. OCs increase serum triglycerides 30-50%. OCs increase insulin secretion and hyperinsulinemia increases the cardiovascular risk. Practitioners should evaluate clients before prescribing OCs. They should not prescribe OCs to women with hypertension, diabetes mellitus, lipid disorders, gynecological cancers, and previous cardiovascular disorders. Practitioners should tell clients that smoking is a leading risk factor and about OC's side effects (e.g., menstrual disturbances). The physical exam should include a cervical PAP smear, gynecological exam of the uterus and the ovaries, and a breast exam. Practitioners should test cholesterol and triglycerides before and during OC use. Premenopausal healthy women with no risk factors can use low-dose OCs.
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PMID:Update on oral contraception. 836 2

Progesterone and the synthetic progestins used in oral contraceptives are associated with a dose-dependent impairment of carbohydrate metabolism. Hyperinsulinemia and alterations in glucose metabolism are significant risk factors for the development of cardiovascular disease. However, long-term use of OCs does not appear to increase the risk of cardiovascular disease. In addition, long-term studies do not indicate any trend toward diabetes in long-term users. Desogestrel, a new progestin derived from 19-nortestosterone, is highly selective for progesterone receptors, with little affinity for androgen receptors. Of the four small studies using 150 mcg monophasic desogestrel and 30 mcg ethinyl estradiol (EE) mild increases in blood glucose were shown in one study after 6 months and after 12 months in another. In addition, plasma insulin decreased in two studies, increased in one, and remained unchanged in one. In a large cross-sectional study, users of OCs for at least 3 months were compared with nonusers. All OC formulations were associated with a deterioration in glucose tolerance. The smallest effect on both glucose tolerance and insulin secretion, as indicated by the C-peptide response, was found with the desogestrel-containing monophasic preparations. In a follow-up study, the metabolic basis of insulin disturbances was investigated as a consequence of the use of combination OCs containing levonorgestrel, norethindrone, or desogestrel as well as progestin-only formulations (norethindrone or ethynodiol diacetate). The levonorgestrel-containing combinations had the greatest effect on intravenous glucose tolerance tests, insulin, and C-peptide concentrations, followed by desogestrel and low-dose norethindrone. The new low-dose OCs show slight decreases in glucose tolerance, usually from 10% to 15% increases in glucose and from 10% to 30% increases in insulin curves compared with base-line. Desogestrel has been demonstrated to have generally less pronounced effects on these parameters of carbohydrate metabolism.
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PMID:Effects of desogestrel on carbohydrate metabolism. 844 58

To investigate the effects on glucose and insulin metabolism of the slightly E-dominant, monophasic, low-dose oral contraceptive (OC) Diane-35, which contains 35 mcg ethinyl estradiol and 2 mg cyproterone acetate, a 17 alpha-hydroxyprogesterone derivative, the euglycemic hyperinsulinemic glucose clamp technique test was performed in 7 health young women after a one-year trial. The 7 subjects had a mean age of 22 years, a body mass index of 20.4 kg/m sq., had either never used OCs or had discontinued use at least 8 weeks before the study, were not taking medication, had no history of obesity or diabetes, and had normal glucose tolerance. The metabolic test was performed within the last 7 days before the presumed onset of menstruation during the last pretreatment cycle and within the last 5 days of OC intake during the sixth and twelfth cycle of continuous treatment with the OC. It was found that the glucose infusion rate, glucose metabolic clearance rate, and glucose infusion rate divided by plasma insulin plateau levels were not significantly affected by the OC. The metabolic clearance rate of the exogenous insulin infused during the clamp technique test was significantly increased after 6 cycles but not after 12. It was concluded that a 1-year treatment with Diane-35 does not alter peripheral (and presumable muscular) insulin sensitivity significantly, but increases insulin (presumably hepatic) clearance slightly.
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PMID:Effects of a 1-year treatment with a low-dose combined oral contraceptive containing ethinyl estradiol and cyproterone acetate on glucose and insulin metabolism. 845 99

Clinical and histopathological features of postmenopausal endometrial cancer were studied in 63 patients who had received exogenous estrogens previously and in 76 patients who had never been exposed to estrogens. All treatments were primarily surgical. Estrogen users were younger than nonusers (P < 0.001). Body mass index, age at menarche and menopause, parity, and blood pressure were comparable in the two groups. Prevalence of diabetes mellitus was higher in nonusers (P < 0.01). Tumor stage was earlier (P < 0.001) and the histologic grade was lower (P < 0.001) in estrogen users compared to nonusers, and the frequency of clear cell and adenosquamous carcinoma was lower in estrogen users. Myometrial invasion was less pronounced in estrogen users, independently of grade and stage (P < 0.01). Number of mitoses correlated significantly with grade and with estrogen use. Features such as squamous metaplasia and "foam" cells were not related to tumor grade or use of estrogens. The receptor content correlated inversely with grade but was not related to estrogen use. Duration of estrogen treatment was not associated with tumor stage and grade. Our findings support the theory that endometrial cancer of estrogen users may be less aggressive than cancer of nonusers.
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PMID:Endometrial cancer in postmenopausal women with and without previous estrogen replacement treatment: comparison of clinical and histopathological characteristics. 850 92


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