Background. Women with diabetes mellitus type I and type II need effective contraception for personal and medical reasons. Long acting reversible contraceptive (LARC) methods are among the most efficient and cost-effective methods. Study Design. We searched the Popline, PubMed, and clinicaltrials.gov databases from 1961 to March 2013 for studies on the efficacy of the IUD in diabetic women and the possible changes it may produce in laboratory parameters. Studies of at least 30 subjects with DM1 or DM2 who were studied for 6 to 12 months depending on the method of analysis were eligible. Results. The search produced seven articles which gave event rate efficacy evaluable results and three which evaluated the effect of the IUD on laboratory parameters. One of the earlier efficacy studies showed an abnormally high pregnancy rate which sparked a controversy which is discussed in the Introduction section. The remaining 6 studies produced acceptable pregnancy rates. The three laboratory studies showed that the copper and levonorgestrel releasing IUD/IUS do not affect the diabetic state in any way. Conclusions. The copper bearing and levonorgestrel releasing IUDs are safe and effective in women with diabetes type I and diabetes type II although the evidence in the latter is limited. 1. Introduction Diabetes mellitus is a ubiquitous disease. The affluent world is engulfed in an epidemic of diabetes mellitus type II (DM2) [1]. Before the discovery of insulin, diabetes mellitus type I (DM1) sufferers died very rapidly. Historically, short life spans and inadequate nutrition made diabetes mellitus type II (DM2) very uncommon. Initially DM2 was termed “aged onset” or “maturity onset” diabetes indicating that it appeared in later life. This is no longer the case. It is now prevalent even in the young [1] and it will affect many women who are of reproductive age and who may want to use contraception. Many will be suited to and may want to use a long acting reversible contraceptive (LARC) method such as the intrauterine device (IUD). During the late 1970s the possible problem of the IUD in Insulin dependent diabetes mellitus (IDDM) emerged. This was at a time when the concern was that IUDs could cause infection [2] and women with diabetes mellitus were also considered poor candidates for the combined oral contraceptives [3] that were available at the time. Diabetic women of reproductive age (almost exclusively with what is now termed DM1) were left with limited options as injectable contraception was not yet available in Europe and North America. This left only the
References
[1]
A. Fagot-Campagna, D. J. Pettitt, M. M. Engelgau et al., “Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective,” Journal of Pediatrics, vol. 136, no. 5, pp. 666–672, 2000.
[2]
L. Westrom, L. P. Bengtsson, and P. A. Mardh, “The risk of pelvic inflammatory disease in women using intrauterine contraceptive devices as compared to non users,” The Lancet, vol. 2, no. 7979, pp. 221–224, 1976.
[3]
J. M. Steel and L. J. P. Duncan, “Contraception for the insulin-dependent diabetic woman: the view from one clinic,” Diabetes Care, vol. 3, no. 4, pp. 557–560, 1980.
[4]
J. Wiese and M. Osler, “Contraception in diabetic patients,” Acta Endocrinologica, vol. 75, no. 182, pp. 87–94, 1974.
[5]
J. Wiese, “Intrauterine contraception in diabetic women,” Fertility and Sterility, vol. 28, no. 4, pp. 422–425, 1977.
[6]
J. M. Steel, J. Parboosingh, and L. J. Duncan, “Contraception and diabetes,” Diabetes Care, vol. 2, no. 1, p. 60, 1979.
[7]
C. Gosden, J. Steel, A. Ross, and A. Springbett, “Intrauterine contraceptive devices in diabetic women,” The Lancet, vol. 1, no. 8271, pp. 530–534, 1982.
[8]
B. Larsson, K. Karlsson, and P. K. Liedholm, “Fibrinolytic activity of the endometrium in diabetic women using Cu IUDs,” Contraception, vol. 15, no. 6, pp. 711–716, 1977.
[9]
K. H. Kurz and M. Berger, “Intrauterine contraceptive devices for diabetics,” The Lancet, vol. 2, no. 8300, p. 707, 1982.
[10]
M. Lawless and M. P. Vessey, “Intrauterine devices for diabetics,” The Lancet, vol. 319, no. 8275, p. 807, 1982.
[11]
G. M. Craig, “Diabetes, intrauterine devices, and fibrinolysis,” British Medical Journal, vol. 283, no. 6301, p. 1264, 1981.
[12]
S. O. Skouby and L. M？lsted-Pedersen, “Intrauterine contraceptive devices for diabetics,” The Lancet, vol. 1, no. 8278, p. 968, 1982.
[13]
J. Steel, “IUD use by diabetic women,” British Journal of Family Planning, vol. 8, no. 2, p. 66, 1982.
[14]
M. Thiery, H. van Kets, K. Kurz, R. Rottiers, and R. Derom, “Intrauterine contraceptive devices for diabetic women,” The Lancet, vol. 2, no. 8303, p. 883, 1982.
[15]
G. M. Craig and J. R. Newton, “Contraception in diabetics,” British Medical Journal, vol. 283, no. 6300, p. 1184, 1981.
[16]
D. Moher, A. Liberati, J. Tetzlaff, and D. G. Altman, “Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement,” British Medical Journal, vol. 339, Article ID b2535, 2009.
[17]
M. Lawless and M. Vessey, “Intrauterine device use by diabetic women,” British Journal of Family Planning, vol. 7, no. 4, pp. 110–111, 1982.
[18]
M. Thiery, H. van Kets, and K. Kurtz, “Are IUD's contraindicated in diabetes?” Tijdschrift voor Geneeskunde, vol. 39, no. 11, pp. 705–707, 1983 (Dutch).
[19]
J. A. Elias, “Intra-uterine contraception in diabetic women,” Journal of Obstetrics and Gynaecology, vol. 3, supplement 2, pp. 558–559, 1983.
[20]
G. M. Craig, “The use of intrauterine contraceptive devices in diabetics,” British Journal of Sexual Medicine, vol. 9, no. 81, pp. 44–48, 1982.
[21]
M. Blum, “Gestational diabetes in the past: a relative contraindication for intrauterine contraception,” Advances in Contraception, vol. 1, pp. 131–132, 1985.
[22]
D. W. Cramer, I. Schiff, and S. C. Schoenbaum, “Tubal infertility and the intrauterine device,” The New England Journal of Medicine, vol. 312, no. 15, pp. 941–947, 1985.
[23]
T. M. M. Farley, M. J. Rosenberg, P. J. Rowe, J.-H. Chen, and O. Meirik, “Intrauterine devices and pelvic inflammatory disease: an international perspective,” The Lancet, vol. 339, no. 8796, pp. 785–788, 1992.
[24]
D. Buchsenschutz, “Non-hormonal methods of contraception in diabetic women: reliability, risks, precautions, surveillance,” Journees Annuelles de Diabetologie de l'Hotel-Dieu, pp. 239–252, 1983 (French).
[25]
D. Serfaty, “For and against the IUD in diabetics,” Contraception Fertilite Sexualite, vol. 11, no. 12, pp. 1295–1298, 1983 (French).
[26]
S. O. Skouby, L. Molsted-Pedersen, and A. Kosonen, “Consequences of intrauterine contraception in diabetic women,” Fertility and Sterility, vol. 42, no. 4, pp. 568–572, 1984.
[27]
R. Kimmerle, R. Weiss, M. Berger, and K.-H. Kurz, “Effectiveness, safety, and acceptability of a copper intrauterine device (CU Safe 300) in type I diabetic women,” Diabetes Care, vol. 16, no. 9, pp. 1227–1230, 1993.
[28]
R. Kimmerle, L. Heinemann, and M. Berger, “Intrauterine devices are safe and effective contraceptives for type I diabetic women: further evidence,” Diabetes Care, vol. 18, no. 11, pp. 1506–1507, 1995.
[29]
S. L. Kjos, S. A. Ballagh, M. La Cour, A. Xiang, and D. R. Mishell Jr., “The copper T380A intrauterine device in women with type II diabetes mellitus,” Obstetrics and Gynecology, vol. 84, no. 6, pp. 1006–1009, 1994.
[30]
O. Grigoryan, E. Grodnitskaya, E. Andreeva, M. Shestakova, G. Melnichenko, and I. Dedov, “Contraception in perimenopausal women with diabetes mellitus,” Gynecological Endocrinology, vol. 22, no. 4, pp. 198–206, 2006.
[31]
K. M. Diab and M. M. Zaki, “Contraception in diabetic women: comparative metabolic study of Norplant, depot medroxyprogesterone acetate, low dose oral contraceptive pill and CuT380A,” Journal of Obstetrics and Gynaecology Research, vol. 26, no. 1, pp. 17–26, 2000.
[32]
S. Rogovskaya, R. Rivera, D. A. Grimes et al., “Effect of a levonorgestrel intrauterine system on women with type 1 diabetes: a randomized trial,” Obstetrics and Gynecology, vol. 105, no. 4, pp. 811–815, 2005.
[33]
C. Tietze, “Intrauterine contraception: recommended procedures for data analysis,” Studies in Family Planning, vol. 18, supplement, pp. 1–6, 1967.
[34]
B. Winner, J. F. Peipert, Q. Zhao, et al., “Effectiveness of long-acting reversible contraception,” The New England Journal of Medicine, vol. 366, pp. 1998–2007, 2012.
[35]
World Health Organisation, Improving Access to Quality Care in Family Planning: Medical Eligibility Criteria for Contraceptive Use, World Health Organisation, Geneva, Switzerland), 2nd edition, 2000.
