Heart disease, diabetes and HRT

Heart disease, diabetes and HRT
When it comes to understanding how diabetes and menopause affect each other, healthcare experts are scrambling to find answers. Despite the growing numbers of diabetes patients, including menopausal women, doctors have few resources to consult with as the number of patients dealing with diabetes and menopause increases.

A number of factors including obesity, inactivity, and high cholesterol cause Type-2 diabetes, also known as adult onset diabetes. The risks of diabetes diagnoses increase with age. Menopause is not a cause of diabetes, but it is during the menopausal years when a woman’s risk factors significantly rise.

Dr. Elizabeth Barrett-Connor of the University of California explains the urgency of diabetes and HRT research and how far behind the medical community is lagging. During her presentation at the 21st Annual Meeting of the North American Menopause Society (NAMS), Barrett-Connor presented her colleagues with some startling findings.

Little information exists concerning if and how HRT affects menopausal diabetes patients. Moreover, while it is clear that diabetes increases a patient’s risk for cardiovascular disease and heart attacks, it remains unclear whether HRT may increase or decrease a woman’s chances of developing diabetes.

The diabetes epidemic
Currently, the United States is facing a diabetes epidemic. The rates of diabetes are increasing due to an aging population beset with decades of poor lifestyle habits. Many Americans may have diabetes or prediabetes (formerly called borderline diabetes) and not even know it.

Barrett-Connor notes that only 50% of diabetes cases are diagnosed in older women; the other 50% meet the criteria for diabetes but lack an official diagnosis or treatment strategy. She further noted that as primary healthcare givers, the number of diabetes cases among their patients will overwhelm many doctors. Oddly, diabetic patients are the least likely to be receiving HRT, even fewer in numbers than women without a physician.

Diabetes and HRT studies
One of the biggest challenges facing physicians is the lack of sufficient research into HRT and its effects on diabetes. Does HRT contribute to a patient’s chances of becoming diabetic? What happens to menopausal women who begin taking HRT? Barrett-Connor set out to find the answers but she discovered that there is little information available.

A handful of studies conducted since the 1990s exist, but these investigations were too small in numbers and too short to provide conclusive evidence. Barrett-Connor did present the findings from a couple of clinical studies conducted over several months, and with larger numbers of women. But until further clinical trials are presented, the information is still in its earliest stages.

HRT in diabetes patients
For diabetic women considering taking HRT, working with their doctors is the first step to learning whether traditional HRT is an appropriate treatment option. In some patients, HRT taken in pill form (orally) may cause an increased risk of gallstones. Moreover, this form of HRT may also lead to greater chances of cardiovascular heart disease, particularly women with diabetes.

One alternative is to take HRT in a transdermal prescription or a cream form. This helps lessen developing gallstones and is less likely to contribute to cardiovascular disease. As with any form of HRT, choosing the lowest possible dose is best.

Women may also choose to discuss their personal health history and HRT concerns with their healthcare providers to find the most suitable menopause treatments to work with diabetes management.

Still, much more work is needed. Diabetes and menopause are two major health concerns that will affect greater numbers of women in the coming decades. Until more information is available, women and their doctors need to work together in a more proactive approach to patient healthcare to prevent or at least to help deal with pressing healthcare issues.

Barrett-Connor, Elizabeth, MD, Dept. of Family & Preventative Medicine, University of California, San Diego, La Jolla, CA. ‘Gaps in Knowledge About Hormone Therapy & Diabetes,’ presentation at the 21st Annual Meeting of NAMS, Chicago, IL 2010.

Menopause, Your Doctor, and You

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