Combined estrogen replacement therapy on metabolic control in postmenopausal women with diabetes mellitus

Abstract

Previous studies have shown that the incidence of diabetes is higher when women come to menopause. This study was carried out to examine the effects of combined estrogen replacement therapy (ERT) on diabetes in postmenopausal women. PubMed/MEDLINE was searched for English-language articles published between January 1997 and June 2011. Studies that examined ERT on the incidence of diabetes and randomized clinical trials that evaluated combined ERT (estrogen plus progesterone) on diabetic indices in postmenopausal women were included. Pooled relative risks were calculated using a random- or a fixed-effects model. Sixteen studies comprising 17,971 cases were included. Based on the pooled data, ERT significantly reduced the incidence of diabetes [odds ratio (OR), 0.61; 95% confidence interval (CI), 0.55-0.68, ERT past/current/continuous use vs. never use; OR, 0.57; 95% CI, 0.51-0.65, ERT current/continuous use vs. past/never use]. Women with combined ERT have significantly lower levels of fasting plasma glucose (mean difference, -1.41 mM/L; 95% CI, -2.49 to -0.33 mM/L) and HbA1c (mean difference, -0.73%; 95% CI, from -1.28 to -0.18%) compared with placebo. Furthermore, combined ERT dramatically reduced plasma total cholesterol (mean difference, -0.34 mM/L; 95% CI, from -0.53 to -0.15 mM/L) and low-density lipoprotein (mean difference, -0.43 mM/L; 95% CI, from -0.71 to -0.14 mM/L) but slightly increased high-density lipoprotein (mean difference, 0.02 mM/L; 95% CI, from -0.07 to 0.12 mM/L) levels as compared with placebo control. This systemic review and meta-analysis provides evidence that postmenopausal women taking low-dose combined ERT have a decreased risk of developing diabetes and have better diabetic control.

RAS and sex differences in diabetic nephropathy

“…In a systemic review and meta-analysis of 16 studies comprised of 17,971 cases, postmenopausal women taking low-dose combined ERT (estrogen and progesterone) showed a decreased risk of developing diabetes and better diabetic control. Specifically, ERT significantly reduced the incidence of diabetes and the levels of fasting plasma glucose, hemoglobin A 1c (HbA 1c ), total cholesterol, and low-density lipoprotein (139). In contrast, ERT had no significant effect on microalbuminuria, glucose levels, or lipid profile in 60 healthy postmenopausal patients receiving E 2 in a prospective randomized double-blind placebo-controlled study (64).…”

Prevalence of metabolic syndrome in pre- and postmenopausal women

“…In some cases, after an individual evaluation, hormone replacement therapy was recommended (44), which could have a positive effect on lipids by reducing total and LDL cholesterol and by slightly increasing HDL levels, as demonstrated in a meta-analysis (45).…”

Impact of menopause and diabetes on atherogenic lipid profile: is it worth to analyse lipoprotein subfractions to assess cardiovascular risk in women?

“…A systematic review which included 16 trials with 17,971 postmenopausal women with type 2 DM demonstrated that estrogen replacement diminishes DM incidence and improves glycemic control [169], but there is no consensus yet.…”

“…To date, there is insufficient evidence to recommend lipoprotein subfractions determination in clinical practice in both sexes at lower or higher cardiovascular risk [169]. Evidence that this measurement would impact on lipid-lowering treatment strategies is lacking either [170].…”