The Effect of Postmenopausal Hormone Therapy on Glucose Regulation in Women with Type 1 or Type 2 Diabetes: A Systematic Review and Meta-analysis

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posted on 2023-09-20, 00:10 authored by Esther M. Speksnijder, Gaby V. ten Noever de Brauw, Arjan Malekzadeh, Peter H. Bisschop, Dirk Jan Stenvers, Sarah E. Siegelaar

BACKGROUND

Blood glucose regulation in women with diabetes mellitus may change during and after menopause, which could be attributed, in part, to decreased estrogen levels.

PURPOSE

To determine the effect of postmenopausal hormone therapy (HT) on HbA1c, fasting glucose, postprandial glucose, and use of glucose lowering drugs in women with type 1 and type 2 diabetes.

DATA SOURCES

A systematic search was conducted in Medline, Embase, Scopus, the Cochrane Library, and the clinicaltrials.gov registry to identify randomized-controlled trials (RCTs).

STUDY SELECTION

We selected RCTs on the effect of HT containing estrogen therapy in postmenopausal women (≥12 months since final menstrual period) with type 1 or type 2 diabetes.

DATA EXTRACTION

Data were extracted for the following outcomes: HbA1c, fasting glucose, postprandial glucose, and the use of glucose lowering medication.

DATA SYNTHESIS

Nineteen RCTs were included (12 parallel-group trials and 7 crossover trials), with a total of 1,412 participants, of which 4.0% had type 1 diabetes. HT reduced HbA1c (mean difference -0.56% [95% CI -0.80, -0.31], -6.08 mmol/mol [95% CI -8.80, -3.36]) and fasting glucose (mean difference -1.15 mmol/L [95% CI -1.78, -0.51]).

LIMITATIONS

Fifty percent of included studies were at high risk of bias.

CONCLUSIONS

When postmenopausal HT is being considered for menopausal symptoms in women with type 2 diabetes, HT is expected to have a neutral to beneficial impact on glucose regulation. Evidence for the effect of postmenopausal HT in women with type 1 diabetes was limited.