TY - JOUR
TI - Therapeutic strategies for type 2 diabetes mellitus in women after menopause
AU - Paschou, S.A.
AU - Marina, L.V.
AU - Spartalis, E.
AU - Anagnostis, P.
AU - Alexandrou, A.
AU - Goulis, D.G.
AU - Lambrinoudaki, I.
JO - Maturitas
PY - 2019
VL - 126
TODO - null
SP - 69-72
PB - Elsevier Ireland Ltd
SN - 0378-5122
TODO - 10.1016/j.maturitas.2019.05.003
TODO - 2,4 thiazolidinedione derivative;  alcohol;  canagliflozin;  dipeptidyl peptidase IV inhibitor;  glucagon like peptide receptor agonist;  hemoglobin A1c;  insulin;  metformin;  sodium;  antidiabetic agent, alcohol consumption;  bariatric surgery;  body weight loss;  diabetic patient;  exercise;  female;  glucose homeostasis;  glycemic control;  hemoglobin blood level;  hormonal therapy;  human;  hypertension;  hypoglycemia;  hypotension;  insulin treatment;  lifestyle;  lifestyle modification;  menopausal hormone therapy;  menopause;  neuropathy;  non insulin dependent diabetes mellitus;  obese patient;  postmenopause;  retinopathy;  Review;  smoking cessation;  sodium intake;  estrogen therapy;  non insulin dependent diabetes mellitus;  postmenopause, Diabetes Mellitus, Type 2;  Estrogen Replacement Therapy;  Female;  Humans;  Hypoglycemic Agents;  Life Style;  Postmenopause
TODO - 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 (HbA1c) 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. © 2019 Elsevier B.V.
ER -