The aim of the present study was to evaluate the effect of three different combinations of
hormone replacement therapy (HRT) on insulin secretion, peripheral
insulin sensitivity, serum
lipid levels and parameters of oxidative stress. Seven type II diabetic women of mean age 55.4 +/- 4.7 years, who had been menopausal for an average of 5 years, were enrolled in the study. Phases of insulin secretion--first (FPIS) and second (SPIS)--and the area under the curve (AUC) for insulin secretion were studied during an intravenous
glucose tolerance test (IVGTT).
Insulin sensitivity was determined using the manual euglycemic-hyperinsulinemic clamp technique. Three different HRT combinations were applied consecutively for 3-month periods:
estradiol valerate plus
cyproterone acetate (
Climen); transdermal
17 beta-estradiol (System TTS 50) plus
dydrogesterone (
Duphaston) 10 mg daily for 10 days a month; oral
17 beta-estradiol plus
dydrogesterone (
Femoston) for 14 days a month. A group of nine women with normal
glucose tolerance (according to World Health Organization criteria during a 75-g oral
glucose tolerance test (OGTT)), of mean age 50.1 +/- 8.2 years and mean body mass index 24.60 +/- 2.01 kg/m2, were also studied, and served as a control group. Insulin secretion improved significantly after
Climen: FPIS increased by 16% and SPIS by 44%.
Insulin sensitivity increased by 50% after Systen TTS 50 +
Duphaston; fasting
hyperinsulinemia was normalized and total
antioxidant capacity of the serum (TAOCS) was significantly raised (p < 0.01).
Femoston led to an increase in
insulin sensitivity (by 23%) and in TAOCS (p < 0.05), while fasting
hyperinsulinemia remained unchanged. HRT should be prescribed in type II diabetic postmenopausal women because of its favorable effect on existing pathophysiological defects.
Cyproterone acetate should be preferred in cases with a predominant beta-cell insulin secretion defect, while
dydrogesterone in combination with a transdermal
estrogen should be recommended in cases with leading
insulin resistance.