[Hormone replacement therapy at menopause in the diabetic woman]

Epidemiological: higher coronary risk in female diabetic patients than in male diabetic patients. Physiopathological: disturbance of lipid metabolism and endothelial nitric oxide (NO) production, seen in both menopausal and diabetic subjects. Hormonal: hyperandrogenism and excessively high blood oestradiol levels in diabetic menopausal women in relation to non-diabetic menopausal women. HRT in menopausal diabetic women Efficacy against climacteric disorders and osteoporosis. No major risks since the effects on lipoproteins are not significant and there are some positive effects on hepatic glucose production during hyperinsulinaemic clamp, provided triglycerides are below 2 mmol/l. Relatively positive effects have been noted in cohort studies such as the Nurses' Health Study and in a study measuring carotid intima-media thickness, but marked bias occurred in recruitment. HRT and coronary disease in diabetic and non-diabetic women Harmful effects were noted, particularly in the HERS study, with a higher incidence of fatal and non-fatal thromboembolic and/or coronary events. Other studies are underway using both conjugated equine estrogens (Women's Health Initiative) and SERMs (raloxifen and tamoxifen).