Effect of oestrogen plus progestin on the incidence of diabetes in postmenopausal women: results from the Women's Health Initiative Hormone Trial
Effect of oestrogen plus progestin on the incidence of diabetes in postmenopausal women: results from the Women's Health Initiative Hormone Trial
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DOI：
10.1007/s00125-004-1448-x
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发表时间：
2004-07-01
期刊：
影响因子：
8.2
通讯作者：
Howard, BV
中科院分区：
文献类型：
--
作者：
Margolis, KL;Bonds, DE;Howard, BV
目标/假设。研究绝经后激素治疗对血糖浓度、胰岛素和糖尿病发病率的影响尚无定论，部分原因是许多研究规模太小。我们研究了雌激素加孕激素对糖尿病发病率和胰岛素抵抗的影响。方法。该研究是一项随机、双盲试验，比较了每日 0.625 毫克结合马雌激素加 2.5 毫克醋酸甲羟孕酮与安慰剂在 5.6 年随访期间的效果。参与者是参加妇女健康倡议激素试验的 15,641 名绝经后妇女。这些女性年龄在 50 岁至 79 岁之间，她们的子宫都完好无损。糖尿病发病率通过胰岛素或口服降血糖药物治疗的自我报告来确定。在基线以及 1 年和 3 年时测量随机样本的空腹血糖、胰岛素和脂蛋白。结果。激素治疗组治疗糖尿病的累积发生率为 3.5%，安慰剂组为 4.2%（风险比 0.79，95% CI 0.67-0.93，p=0.004）。根据 BMI 和腰围的变化进行调整后，风险比几乎没有变化。在随访的第一年，空腹血糖和胰岛素的变化表明，与对照组相比，积极治疗的女性胰岛素抵抗显着下降（第一年至基线组间差异-0.22+/-0.10，p=0.03）。解释/结论。这些数据表明，雌激素和孕激素联合治疗可降低糖尿病的发病率，这可能是通过与体型无关的胰岛素抵抗降低介导的。替代绝经后激素治疗方案和选择性雌激素激动剂和/或拮抗剂的未来研究应考虑这些方案对胰岛素抵抗和糖尿病的影响。
Aims/hypothesis. Studies examining the effect of postmenopausal hormone therapy on concentrations of glucose, insulin and diabetes incidence have been inconclusive, in part because many of the studies were too small. We examined the effect of oestrogen plus progestin on diabetes incidence and insulin resistance.Methods. The study was a randomised, double-blind trial comparing the effect of daily 0.625 mg conjugated equine oestrogens plus 2.5 mg medroxyprogesterone acetate with that of placebo during 5.6 years of follow-up. The participants were 15,641 postmenopausal women enrolled in the Women's Health Initiative Hormone Trial. These women were aged 50 to 79 and all had an intact uterus. Diabetes incidence was ascertained by self-report of treatment with insulin or oral hypoglycaemic medication. Fasting glucose, insulin, and lipoproteins were measured in a random sample at baseline and at 1 and 3 years.Results. The cumulative incidence of treated diabetes was 3.5% in the hormone therapy group and 4.2% in the placebo group (hazard ratio 0.79, 95% CI 0.67-0.93, p=0.004). There was little change in the hazard ratio after adjustment for changes in BMI and waist circumference. During the first year of follow-up, changes in fasting glucose and insulin indicated a significant fall in insulin resistance in actively treated women compared to the control subjects (Year 1 to baseline between-group difference -0.22+/-0.10, p=0.03).Interpretations/conclusion. These data suggest that combined therapy with oestrogen and progestin reduces the incidence of diabetes, possibly mediated by a decrease in insulin resistance unrelated to body size. Future studies of alternative postmenopausal hormone therapy regimens and selective oestrogen agonists and/or antagonists should consider the effects of these regimens on insulin resistance and diabetes.