Endocrine Abstracts

Prescription rates for HRT in women with type 2 diabetes are low. One reason for this is concern about adverse metabolic effects although evidence on this is limited. We report results from a 3-month randomised, double blind, placebo-controlled trial of 1mg 17-beta oestradiol combined with 0.5 mg norethisterone acetate in postmenopausal women with type 2 diabetes. The study has full local ethics committee approval.

29 subjects entered the study; 1 taking HRT withdrew following a cerebrovascular accident and another taking placebo withdrew due to leg swelling. Insulin sensitivity was assessed by the isoglycaemic hyperinsulinaemic clamp, and is expressed as metabolic clearance rate (MCR) of glucose. Results are expressed as mean plus/minus SD and comparison between groups was by unpaired T-tests.

There were no significant differences between active and placebo groups at baseline with regard to age (62.2 plus/minus 5.8 versus 62.0 plus/minus 4.0 years, p= 0.019), weight (82.0 plus/minus 16.4 versus 80.0 plus/minus 10.9 kg, p= 0.770), fasting glucose (8.1 plus/minus 1.9 versus 8.5 plus/minus 2.0 mmol per litre, p=0.563), HbA1c (7.4 plus/minus 1.1 versus 7.6 plus/minus 0.9%, p=0.650) or MCR (1120 plus/minus 549 versus 1119 plus/minus 468 mg per kg per minute, p=0.996)

After 3 months treatment active group had significantly lower fasting glucose (7.2 plus/minus 1.9 versus 8.9 plus/minus 1.6 mmol per litre, p=0.019). There were no significant differences between groups at follow up for HbA1c (7.4 plus/minus 1.3 versus 8.1 plus/minus 1.1%, p=0.108), MCR (1055 plus/minus 524 versus 1026 plus/minus 511 mg per kg per minute, p=0.887) or weight (82.4 plus/minus 17.4 versus 80.6 plus/minus 11.3 kg, p= 0.744).

We conclude that this HRT preparation decreases fasting glucose without significantly effecting total body insulin sensitivity. Thus, HRT can be used in patients with diabetes without compromising metabolic control, although the long term safety with regard to cardiovascular events is not known.