Lopez Laureen M, Grimes David A, Schulz Kenneth F
Behavioral and Biomedical Research, Family Health International, P.O. Box 13950, Research Triangle Park, North Carolina, USA, 27709.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD006133. doi: 10.1002/14651858.CD006133.pub3.
Many hormonal contraceptives have been associated with changes in carbohydrate metabolism. Alterations may include decreased glucose tolerance and increased insulin resistance, which are risk factors for Type 2 diabetes mellitus and cardiovascular disease. These issues have been raised with progestin-only contraceptives as well as contraceptives containing estrogen. Such potential effects could influence recommendations for, and use of, these widely used and effective contraceptives.
To evaluate the effect of hormonal contraceptives on carbohydrate metabolism in healthy women and those at risk for diabetes due to overweight.
We searched the computerized databases MEDLINE, POPLINE, CENTRAL, EMBASE, and LILACS for studies of hormonal contraceptives and carbohydrate metabolism. We also searched for clinical trials in ClinicalTrials.gov and ICTRP. We wrote to investigators for information about other published or unpublished trials.
All randomized controlled trials were considered if they examined carbohydrate metabolism in women without diabetes who used hormonal contraceptives for contraception. Interventions could include comparisons of a hormonal contraceptive with a placebo, a non-hormonal contraceptive, or another hormonal contraceptive that differed in drug, dosage, or regimen. Interventions included at least three cycles. Outcomes included glucose and insulin levels, which were generally reported as fasting value or response to an oral glucose tolerance test.
We assessed for inclusion all titles and abstracts identified during the literature searches with no language limitations. The data were abstracted and entered into RevMan. Studies were examined for methodological quality. For continuous variables, the mean difference was computed with 95% confidence interval (CI) using a fixed-effect model. For dichotomous outcomes, the Peto odds ratio with 95% CI was calculated.
We found 43 trials that met the inclusion criteria. No study stratified by body weight (normal-weight versus overweight women). Results for desogestrel were often favorable regarding carbohydrate metabolism but inconsistent overall. Glucose and insulin means were more favorable for norethisterone in studies of progestin-only contraceptives. For other progestins, little or no difference was noted across trials.
AUTHORS' CONCLUSIONS: Current evidence suggests that hormonal contraceptives have limited effect on carbohydrate metabolism in women without diabetes. Strong statements cannot be made, though, due to having few studies that compared any particular types of contraceptives. Many trials had small numbers of participants and some had large losses. Many studies had poor reporting of methods. No information was available regarding the effects among women who were overweight.
许多激素避孕药都与碳水化合物代谢的变化有关。这些变化可能包括葡萄糖耐量降低和胰岛素抵抗增加，而这两者都是2型糖尿病和心血管疾病的危险因素。这些问题在仅含孕激素的避孕药以及含有雌激素的避孕药中均有出现。此类潜在影响可能会影响对这些广泛使用且有效的避孕药的推荐及使用。
评估激素避孕药对健康女性以及因超重而有糖尿病风险的女性碳水化合物代谢的影响。
我们在计算机化数据库MEDLINE、POPLINE、CENTRAL、EMBASE和LILACS中检索有关激素避孕药与碳水化合物代谢的研究。我们还在ClinicalTrials.gov和ICTRP中检索临床试验。我们写信给研究人员以获取有关其他已发表或未发表试验的信息。
如果研究考察了使用激素避孕药进行避孕的非糖尿病女性的碳水化合物代谢情况，则所有随机对照试验均在考虑范围内。干预措施可包括将一种激素避孕药与安慰剂、非激素避孕药或另一种在药物、剂量或用药方案上不同的激素避孕药进行比较。干预措施至少包括三个周期。结局指标包括血糖和胰岛素水平，这些指标通常报告为空腹值或口服葡萄糖耐量试验的反应。
我们评估纳入所有在文献检索中识别出的标题和摘要，无语言限制。数据被提取并录入RevMan。对研究进行方法学质量检查。对于连续变量，使用固定效应模型计算平均差值及95%置信区间（CI）。对于二分结局，计算Peto比值比及95%CI。
我们发现43项试验符合纳入标准。没有研究按体重分层（正常体重与超重女性）。对于去氧孕烯，在碳水化合物代谢方面结果通常较好，但整体并不一致。在仅含孕激素避孕药的研究中，炔诺酮的血糖和胰岛素均值更有利。对于其他孕激素，各试验间差异很小或未观察到差异。
目前的证据表明，激素避孕药对非糖尿病女性碳水化合物代谢的影响有限。然而，由于比较任何特定类型避孕药的研究较少，无法得出有力结论。许多试验参与者数量较少，一些试验有大量失访。许多研究方法报告不佳。关于超重女性的影响尚无可用信息。
