Hormone replacement therapy for women with type 1 diabetes mellitus

There are increasing numbers of people living with type 1 diabetes mellitus. The main aim of treatment for diabetes is to maintain good quality of life and to minimise, or prevent, the development of diabetic complications by controlling blood glucose levels. Women with type 1 diabetes frequently express difficulties in controlling their blood glucose levels during the menopausal phase of their lives. However, the cause of this has not been explored.

Hormone replacement therapy is a treatment that is prescribed to many women to alleviate the symptoms associated with the menopause.

The literature surrounding hormone replacement therapy and type 1 diabetes has never been systematically searched and reviewed.

The evidence available for healthcare professionals to call upon relating to the management of menopausal women with type 1 diabetes is vague. There is conflicting literature regarding the use of hormone replacement therapy in women with type 1 diabetes, as many of the studies also included women with type 2 diabetes. We found one study with a type 1 diabetes subgroup involving 56 participants receiving either hormone replacement therapy or placebo over 12 months. No statistically significant differences were found between hormone replacement therapy and placebo. Patient-important outcomes like death from any cause, cardiovascular disease (for example, heart attack, stroke), diabetic complications (for example, diabetic eye disease, diabetic kidney disease) or health-related quality of life were not investigated.

Authors' conclusions: 

There is a lack of evidence around the use of HRT in women with type 1 diabetes. The one study that has been undertaken in this area is underpowered. More RCTs are required in the area to examine the impact of HRT on glycaemic control and cardiovascular outcomes.

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Background: 

There is conflicting information about the impact of the menopause on glycaemic control amongst women with type 1 diabetes. Some menopausal women with type 1 diabetes are treated with hormone replacement therapy (HRT) but the effects of this treatment have, to date, not been established.

Objectives: 

To assess the effects of HRT for women with type 1 diabetes mellitus.

Search strategy: 

We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsycINFO from their inception to June 2012. The last search was run for all databases on 18 June 2012.

Selection criteria: 

We selected randomised controlled trials or controlled clinical trials that involved peri- or postmenopausal women with type 1 diabetes undergoing HRT as an intervention.

Data collection and analysis: 

Two researchers independently applied the inclusion criteria to the identified studies and assessed risk of bias. Disagreements were resolved by discussion or by intervention by a third party. Descriptive analysis was conducted for the review.

Main results: 

Ninety-two publications were screened. No studies met the inclusion criteria exclusively but one study that included both type 1 and type 2 diabetes participants was considered. This randomised clinical trial (RCT) compared HRT (N = 27) with placebo (N = 29) over 12 months. The outcome measures were cardiovascular risk factors, including lipid profile, glycaemic control, blood pressure and body weight. No significant differences between placebo and HTR were detected. Patient-important outcomes like all-cause mortality, cardiovascular disease, diabetic complications or health-related quality of life were not investigated.

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