Glycaemic control and plasma lipoproteins in menopausal women with Type 2 diabetes treated with oral and transdermal combined hormone replacement therapy

Aims: 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 I I 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 less than or equal to 0.005). Oral HRT additionally reduced the cell adhesion factor E-selectin (82 +/- 33 to 60 +/- 20 mug 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 mug 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. Conclusion: 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. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.