Therapeutic strategies for type 2 diabetes mellitus in women after menopause

Stavroula A Paschou; Ljiljana V Marina; Eleftherios Spartalis; Panagiotis Anagnostis; Andreas Alexandrou; Dimitrios G Goulis; Irene Lambrinoudaki

doi:10.1016/j.maturitas.2019.05.003

Therapeutic strategies for type 2 diabetes mellitus in women after menopause

Maturitas. 2019 Aug:126:69-72. doi: 10.1016/j.maturitas.2019.05.003. Epub 2019 May 14.

Authors

Stavroula A Paschou¹, Ljiljana V Marina², Eleftherios Spartalis³, Panagiotis Anagnostis⁴, Andreas Alexandrou⁵, Dimitrios G Goulis⁴, Irene Lambrinoudaki⁶

Affiliations

¹ Division of Endocrinology and Diabetes, Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: s.a.paschou@gmail.com.
² Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
³ Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁴ Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁵ First Department of Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁶ Division of Endocrinology and Diabetes, Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

PMID: 31239121
DOI: 10.1016/j.maturitas.2019.05.003

Abstract

As type 2 diabetes mellitus (T2DM) is affected by both chronological and ovarian ageing, it is common in postmenopausal women. This review analyses and critically appraises the literature regarding the optimal therapeutic strategies for T2DM in women after menopause. Lifestyle interventions, including changes in dietary habits and physical exercise in everyday life targeting a modest weight loss (5%), represent the cornerstone of management. Limited intake of alcohol and sodium, as well as smoking cessation, are additional lifestyle changes for both endothelial and bone health. Regarding medications, postmenopausal women should be initially treated with metformin, concurrently with lifestyle intervention. If glycosylated haemoglobin (HbA_1c) remains over the target level (usually ≥7%), dipeptidyl peptidase-4 inhibitors (DPP-4i) or glucagon-like peptide-1 receptor agonists (GLP-1RA) should be preferred. Thiazolidinediones (TZDs) and canagliflozin should be avoided in postmenopausal women with increased fracture risk. Insulin should be used with caution to avoid hypoglycaemia. Bariatric surgery is a well established and effective therapeutic option for both weight loss and glycaemic control in very obese patients with T2DM; however, metabolic benefits should be balanced against nutritional deficiencies that often present after surgery. Proper control of hypertension, with avoidance of hypotension, is of great importance as a measure against falls. Annual tests for retinopathy and neuropathy are crucial for the same reason. Menopausal hormone therapy (MHT) has a beneficial effect on glucose homeostasis, reduces the risk of new-onset T2DM and improves glucose control in women with T2DM. T2DM has been considered a cardiovascular disease equivalent, which meant that postmenopausal women with the disease could not take MHT but current evidence supports an individualised approach to this issue. Therapeutic strategies for women with T2DM after menopause should aim to maximise benefits for metabolic, cardiovascular and bone health with the minimum of adverse effects, bearing in mind that most women will spend more than one-third of their life being of postmenopausal status.

Keywords: Anti-diabetic medications; Hormone replacement therapy; Menopausal hormone therapy; Menopause; Type 2 diabetes mellitus.

Publication types

Review

MeSH terms

Diabetes Mellitus, Type 2 / therapy*
Estrogen Replacement Therapy
Female
Humans
Hypoglycemic Agents / therapeutic use
Life Style
Postmenopause*

Substances

Hypoglycemic Agents