Glycaemic control and plasma lipoproteins in menopausal women with Type 2 diabetes treated with oral and transdermal combined hormone replacement therapy.
OBJECTIVE
To compare the effect of a fixed combination of an oestrogen (17-beta oestradiol) with a cyclical progestagen (norethisterone) on glycaemic control, plasma lipoproteins and haemostatic factors in women with Type 2 diabetes.


METHODS
Oral and transdermal hormone replacement therapy (HRT) were compared to no HRT treatment in 33 postmenopausal women with Type 2 diabetes, in a 12-week randomised prospective open parallel group study.


RESULTS
In the 11 women who received 12 weeks of oral HRT, there was a significant fall in total cholesterol (5.9+/-1.0 (S.D.) to 4.7+/-1.0 mmol l(-1), P=0.005), low density lipoprotein cholesterol (3.44+/-0.89 to 2.77+/-0.92 mmol l(-1), P=0.005) and triglyceride values (median (range)), (2.46 (0.96-5.52) to 2.29 (1.00-3.87) mmol l(-1), P<0.05). Oral HRT improved glycated haemoglobin (HbA(1c)) (7.4+/-1.4 to 6.8+/-1.2%, P< or =0.005). Oral HRT additionally reduced the cell adhesion factor E-selectin (82+/-33 to 60+/-20 microg l(-1), P<0.01) and factor VII (143+/-25 to 109+/-24% pooled plasma activity, P<0.01). No improvement in any of these parameters, except E-selectin (65+/-19 to 58+/-18 microg l(-1), P<0.01), occurred in the nine women receiving transdermal HRT, and no improvement occurred in the 13 controls randomised to no treatment.


CONCLUSIONS
In women with Type 2 diabetes, cyclical oestrogen and progestagen taken orally for 12 weeks significantly improved glycaemic control and lipoprotein concentrations. These metabolic benefits were not apparent when a similar HRT preparation was administered transdermally.
Darko
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DA
Department of Metabolic Medicine, Imperial College School of Medicine at Charing Cross Hospital, London W6 8RF, UK. d.darko@virgin.net
Dornhorst
A
A
Kennedy
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G
Mandeno
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RC
Seed
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M
D000279:Administration, Cutaneous; D000284:Administration, Oral; D001786:Blood Glucose / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D019040:E-Selectin / Q000097:blood; D004958:Estradiol / Q000097:blood / Q000494:pharmacology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D007328:Insulin / Q000097:blood; D009640:Norethindrone / Q000008:administration & dosage / Q000494:pharmacology*; D017698:Postmenopause / Q000097:blood*; D045167:Progesterone Congeners / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D002784:Cholesterol; D019040:E-Selectin; D004958:Estradiol; D006442:Glycated Hemoglobin; D007328:Insulin; D009640:Norethindrone; D045167:Progesterone Congeners; D014280:Triglycerides