Effect of Implantable Contraception on Type-2 DM and Metabolic Syndrome in Women With History of Gestational DM

Study Overview
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Brief Summary
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The purpose of this study is to determine the effect of implantable contraception on the incidence of diabetes mellitus in women with history of gestational diabetes mellitus comparing with those using nonhormonal contraceptives.

Detailed Description
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Gestational diabetes mellitus (GDM) was defined as abnormal glucose tolerance detected for the first time in pregnancy. GDM is a well-known risk factor for developing overt diabetes later in life, especially type 2 diabetes. About 50-60% of woman with prior GDM will develop type 2 diabetes during their lifetime. Recent studies show that women with previous GDM exhibit a markedly increased prevalence of the metabolic syndrome, even when glucose tolerance is normal. For both maternal and future offspring, women with prior GDM need safe, efficient, and acceptable choices for contraceptive methods that do not enhance their already substantial risk to develop either overt diabetes or metabolic syndrome and associated sequelae. The intrauterine device (IUD) is a very effective and reversible contraceptive method without metabolic disturbances and therefore is an ideal contraceptive for women with prior GDM. Progestins do not increase globulin production; thus, they do not increase coagulation factors or blood pressure. A nonrandomized open-label prospective trial of healthy obese, reproductive-age women in California were studied about the metabolic effects of progestin-only long-acting reversible contraception levonorgestrel-releasing intrauterine system (LNG-IUS) and etonogestrel implant (ENG-I)] comparing with nonhormonal contraception (NHC). The changes in fasting glucose and insulin sensitivity were seen among obese at 3 months.

Official Title
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Effect of Implantable Progestin-only Contraception on the Incidence of Type 2 Diabetes and Metabolic Syndrome in Thai Women With History of Gestational Diabetes

Conditions
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Diabetes Mellitus, Metabolic Syndrome

Intervention / Treatment
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* Device: progestin implant
* Device: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Postpartum women with diagnosis of gestational diabetes mellitus Want to use implant contraception or nonhormonal contraceptions such as IUD or tubal sterilization Exclusion Criteria: Age less than 18 years old Diagnosis of diabetes mellitus at post partum period Cardiovascular disease, Liver disease, autoimmune disease The women that reject to continue in the study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: nonhormonal contraception<br>nonhormonal intrauterine device tubal sterilization | Device: Placebo<br> <br> |
| Experimental: progestin implant<br>Jadelle | Device: progestin implant<br>* two small (2.5 mm × 43 mm) silicone rods each containing 75 mg of levonorgestrel in a polymer matrix<br>* Other names: Jadelle;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diabetes mellitus | Incidence of type-2 DM in women with history of gestational diabetes using implantable contraception. | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| metabolic syndrome | Prevalence of metabolic syndrome in women with history of gestational diabetes using implantable contraception. | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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GDM, implant, diabetes mellitus, metabolic syndrome