Effect of postmenopausal hormone therapy on glucose and insulin concentrations. PEPI Investigators. Postmenopausal Estrogen/Progestin Interventions.
OBJECTIVE
To characterize the long-term impact of four hormone therapy regimens on insulin and glucose concentrations measured during a standard oral glucose tolerance test.


METHODS
The Postmenopausal Estrogen/Progestin Intervention Study was a 3-year placebo-controlled randomized trial to assess effects of four hormone regimens on cardiovascular risk factors. This efficacy analysis describes glucose and insulin concentrations from 788 adherent women at baseline and at 1 and 3 years' postrandomization.


RESULTS
When compared with women taking placebo, those taking conjugated equine estrogen (CEE) at 0.625 mg/day with or without a progestational agent had mean fasting insulin levels that were 16.1% lower, mean fasting glucose levels 2.2 mg/dl lower, and mean 2-h glucose levels 6.4 mg/dl higher (each nominal P < 0.05). No significant differences were apparent between women taking CEE only versus the three progestin regimens: medroxyprogesterone acetate (MPA) at 2.5 mg daily (continuous MPA), MPA at 10 mg on days 1-12 (cyclical MPA), and micronized progesterone (MP) (cyclical) at 200 mg on days 1-12. The impact of hormone therapy on insulin and glucose depended on baseline levels of fasting insulin and 1-h glucose (P < 0.05). However, the treatment effects on carbohydrate metabolism appeared to be consistent across participant subgroups formed by lifestyle, clinical, and demographic characteristics.


CONCLUSIONS
Oral hormone therapy involving 0.625 mg/day of CEE may modestly decrease fasting levels of insulin and glucose. Postchallenge glucose concentrations are increased, however, which may indicate delayed glucose clearance.
Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1063, USA. mespelan@rc.phs.wfubmc.edu
M A
MA
Espeland
P E
PE
Hogan
S E
SE
Fineberg
G
G
Howard
H
H
Schrott
M A
MA
Waclawiw
T L
TL
Bush
D001786:Blood Glucose / Q000378:metabolism*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use*; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000097:blood*; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D010919:Placebos; D017698:Postmenopause / Q000097:blood*; D019518:Postprandial Period; D011374:Progesterone / Q000627:therapeutic use*; D045167:Progesterone Congeners / Q000627:therapeutic use; D013997:Time Factors
D001786:Blood Glucose; D004966:Estrogens, Conjugated (USP); D007328:Insulin; D010919:Placebos; D045167:Progesterone Congeners; D011374:Progesterone; D017258:Medroxyprogesterone Acetate