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Short-term oestrogen replacement therapy improves insulin resistance, lipids and fibrinolysis in postmenopausal women with NIDDM

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Author: Brussaard, H.E. · Gevers Leuven, J.A. · Frölich, M. · Kluft, C. · Krans, H.M.J.
Type:article
Date:1997
Institution: Gaubius Instituut TNO
Source:Diabetologia, 7, 40, 843-849
Identifier: 233999
doi: doi:10.1007/s001250050758
Keywords: Biology · Coagulation factors · Glucose regulation · Hepatic glucose production · Insulin sensitivity · Lipoprotein profiles · Non-insulin-dependent diabetes mellitus · Oestrogen therapy · Apolipoprotein a1 · Apolipoprotein b · Blood clotting factor · Glycosylated hemoglobin · High density lipoprotein cholesterol · Insulin · Low density lipoprotein cholesterol · Plasminogen activator · Adult · Aged · Cardiovascular disease · Cardiovascular risk · Clinical article · Estrogen therapy · Glucogenesis · Non insulin dependent diabetes mellitus · Postmenopause · C-Peptide · Cholesterol · Diabetes Mellitus, Type 2 · Double-Blind Method · Estradiol · Estrogen Replacement Therapy · Fatty Acids, Nonesterified · Female · Fibrinolysis · Hemoglobin A, Glycosylated · Humans · Insulin Resistance · Lipids · Lipoproteins · Middle Aged · Plasminogen Activator Inhibitor 1 · Postmenopause · Tissue Plasminogen Activator · Triglycerides

Abstract

Oestrogen replacement therapy is associated with a decreased risk of cardiovascular disease in postmenopausal women. Patients with non-insulin- dependent diabetes mellitus (NIDDM) have an increased cardiovascular risk. However, oestrogen replacement therapy is only reluctantly prescribed for patients with NIDDM. In a double blind randomized placebo controlled trial we assessed the effect of oral 17 β-estradiol during 6 weeks in 40 postmenopausal women with NIDDM. Glycated haemoglobin (HbA(1c)), insulin sensitivity, suppressibility of hepatic glucose production, lipoprotein profile and parameters of fibrinolysis were determined. The oestrogen treated group demonstrated a significant decrease of HbA(1c) and in the normotriglyceridaemic group a significantly increased suppression of hepatic glucose production by insulin. Whole body glucose uptake and concentrations of non-esterified fatty acids did not change. LDL-cholesterol- and apolipoprotein B levels decreased, and HDL-cholesterol, its subfraction HDL2-cholesterol and apolipotrotein A1 increased. The plasma triglyceride level remained similar in both groups. Both the concentration of plasminogen activator inhibitor-1 antigen and its active subfraction decreased. Tissue type plasminogen activator activity increased significantly only in the normotriglyceridaemic group. Oestrogen replacement therapy improves insulin sensitivity in liver, glycaemic control, lipoprotein profile and fibrinolysis in postmenopausal women with NIDDM. For a definite answer as to whether oestrogens can be more liberally used in NIDDM patients, long term studies including the effect of progestogens are necessary.