Abstract
Context: Adolescents and young women (AYA) with type 1 diabetes (T1D) may require hormonal contraception for an extended period.
However, it is unclear what effect hormonal contraception has on telomere length, a marker of the risk for complications.
Objective: To investigate the relative telomere length (RTL) in AYA with T1D (AYA-T1D) and healthy young women (AYA-C) after 18 months of
combined oral contraception use (COC) with ethinyl estradiol/desogestrel, or a subdermal etonogestrel implant (IM).
Methods: A nonrandomized prospective study was performed in which 39 AYA-T1D and 40 AYA-C chose the COC or the IM. RTL was measured
by monochrome multiplex–quantitative PCR in DNA from peripheral blood mononuclear cells (PBMC). The impact of contraceptives and clinical
variables on RTL was assessed using lineal regression analysis.
Results: Longer RTL compared to baseline was observed in AYA-T1D (P < .05) and AYA-C (P < .01) after using the IM. However, the total of AYA
and the AYA-C group treated with COC decreased RTL after 18 months of treatment compared to baseline (P < .05). The type of contraceptive
used was determinant for the changes in RTL compared to baseline in all subjects and controls (P ≤ .006). For AYA-T1D, HbA1c levels were not
associated with RTL, but the high-sensitivity C-reactive protein was negatively related with the changes in RTL at 18 months compared to
baseline (standardized R2
: 0.230, P = .003).
Conclusion: IM was associated with longer RTL in AYA-T1D and AYA-C. In contrast, a shortening of telomere length in PBMC was observed
after using COC.
Key Words: oral combined contraceptive, subdermal progestin implant, relative telomere length, adolescents and young adults, type 1 diabetes
Abbreviations: AYA, adolescents and young women; BMI, body mass index; COC, combined oral contraceptive; DSG, desogestrel; EE, ethinyl estradiol; ETO,
etonogestrel; HbA1c, glycated hemoglobin; HDL-C, high-density lipoprotein cholesterol; IM, etonogestrel implant; hs-CRP, high-sensitivity C-reactive protein;
JDF, Juvenile Diabetes Foundation; LDL-C, low-density lipoprotein cholesterol; MAP, mean arterial pressure; MM-qPCR, monochrome multiplex–quantitative
chain reaction; PBMC, peripheral blood mononuclear cells; RTL, relative telomere length; T1D, type 1 diabetes; z-BMI, z score of BMI.
Differential Effect of 2 Hormonal Contraceptives on theRelative Telomere Length of Youth With Type 1 Diabetes
