In a study published in Diabetes Care, researchers reported that the absolute risk of thromboembolism among women with type 1 or type 2 diabetes using hormonal contraceptives was low.

Sarah H. O’Brien, from the Nationwide Children’s Hospital, Columbus, OH, and colleagues conducted a study to evaluate the safety of hormonal contraception with regard to thromboembolic events in women with type 1 or type 2 diabetes. They analyzed data from 2002-2011 in the Clinformatics Data Mart to identify women in the U.S. aged 14-44 years old with an ICD-9-CM code for diabetes and a prescription for a diabetic drug or device. 

They compared contraceptive claims and time to thromboembolism (venous thrombosis, stroke, or myocardial infarction) among women with diabetes who were given hormonal contraception. Variables for age, smoking, obesity, hypertension, hyperlipidemia, diabetic complications, and history of cancer were controlled via a modified Cox regression. 

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A total of 14,080 women with diabetes who experienced 3,012 thrombembolic events were identified for the analysis. The data showed 28% of reproductive-aged women with diabetes had claims for hormonal contraception with the majority receiving estrogen-containing oral contraceptives.

The rates of thromboembolism were highest among women who used the patch (16 per 1,000 woman-years) and lowest among women who used intrauterine and subdermal (6 per 1,000 woman-years and 0 per 1,000 women-years, respectively) contraceptives. 

The use of progestin-only injectable contraceptives was associated with a higher risk of thromboembolism when compared to intrauterine contraceptives (12.5 per 1,000 woman-years; adjusted hazard ratio [HR] 4.69, 95% CI: 2.51-8.77).

O’Brien concluded that intrauterine and subdermal contraceptives proved highly effective and serve as “excellent options for women with diabetes who hope to avoid the teratogenic effects of hyperglycemia by carefully planning their pregnancies.”

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