SHORT-TERM ESTROGEN REPLACEMENT THERAPY IMPROVES INSULIN-RESISTANCE, LIPIDS AND FIBRINOLYSIS IN POSTMENOPAUSAL WOMEN WITH NIDDM

Oestrogen replacement therapy is associated with a decreased risk of c ardiovascular disease in postmenopausal women. Patients with non-insul in-dependent diabetes mellitus (NIDDM) have an increased cardiovascula r risk. However, oestrogen replacement therapy is only reluctantly pre scribed for patients with NIDDM. In a double blind randomized placebo controlled trial we assessed the effect of oral 17 beta-estradiol duri ng 6 weeks in 40 postmenopausal women with NIDDM. Glycated haemoglobin (HbA(1c)), insulin sensitivity, suppressibility of hepatic glucose pr oduction, lipoprotein profile and parameters of fibrinolysis were dete rmined. The oestrogen treated group demonstrated a significant decreas e of HbA(1c) and in the normotriglyceridaemic group a significantly in creased suppression of hepatic glucose production by insulin. Whole bo dy glucose uptake and concentrations of non-esterified fatty acids did not change. LDL-cholesterol- and apolipoprotein B levels decreased, a nd HDL-cholesterol, its subfraction HDL2-cholesterol and apolipotrotei n A1 increased. The plasma triglyceride level remained similar in both groups. Both the concentration of plasminogen activator inhibitor-1 a ntigen and its active subfraction decreased. Tissue type plasminogen a ctivator activity increased significantly only in the normotriglycerid aemic group. Oestrogen replacement therapy improves insulin sensitivit y 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 stu dies including the effect of progestogens are necessary.