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HRT Plus Exercise Boosts Insulin Sensitivity in Postmenopausal Women
Confirmed
In Short: A 12-week randomized study found that combining hormone replacement therapy (HRT) with exercise produced the largest observed improvement in insulin sensitivity among postmenopausal women compared to exercise or HRT alone.
A 12-week randomized study found that combining hormone replacement therapy (HRT) with exercise produced the largest observed improvement in insulin sensitivity among postmenopausal women compared to exercise or HRT alone.
According to Patrick Calders, PhD, professor in the Department of Rehabilitation Sciences at Ghent University, the combination of HRT and exercise showed the largest effect on insulin sensitivity.
Exercise alone also produced substantial benefits, with improvements in physical capacity and body composition, and results similar to HRT plus exercise for some outcomes.
The study included 84 menopausal women aged 45-65 years with a BMI of 18.5-30, randomized to HRT alone, exercise alone, or combined HRT and exercise.
The intervention lasted 12 weeks, with HRT consisting of transdermal estrogen at 1.53 mg per dose, applied twice in the morning, plus oral progesterone 100 mg.
The exercise program involved three sessions per week, two supervised by a physiotherapist and one performed at home using a Polar monitor.
While the combination of HRT and exercise showed greater benefits for some outcomes, no significant overall effects on cardiovascular risk factors were observed.
Exercise had a clear positive effect on fat mass, with the largest effect in the group receiving HRT plus exercise.
However, the addition of HRT to exercise did not make a significant difference in fat-free mass.
Menopause is accompanied by a fall in estrogen and changes in body composition, including increased fat mass and reduced lean mass, alongside insulin resistance, hypertension, and hyperlipidemia.
The study aimed to determine whether combining exercise and HRT would have a stronger effect on insulin sensitivity and cardiovascular risk than either intervention alone.
The study's findings suggest that a combination of HRT and exercise may offer the best outcomes for postmenopausal women seeking to improve their insulin sensitivity and overall health.
What this adds
The study did not establish long-term effects of the combined intervention.
The safety and efficacy of the once-weekly injectable basal insulin drug insulin efsitora alfa-gobe (Onswik, Eli Lilly) for type 2 diabetes were supported by evidence from the phase 3 QWINT clinical trial program.
The FDA approved Onswik for use as an adjunct with diet and exercise to help control blood sugar in adults with type 2 diabetes.
What's confirmed
- A 12-week randomized study found that combining hormone replacement therapy (HRT) with exercise produced the largest observed improvement in insulin sensitivity among postmenopausal women compared to exercise or HRT alone.
- According to Patrick Calders, PhD, professor in the Department of Rehabilitation Sciences at Ghent University, the combination of HRT and exercise showed the largest effect on insulin sensitivity.
- Exercise alone also produced substantial benefits, with improvements in physical capacity and body composition, and results similar to HRT plus exercise for some outcomes.
- The study included 84 menopausal women aged 45-65 years with a BMI of 18.5-30, randomized to HRT alone, exercise alone, or combined HRT and exercise.
- The intervention lasted 12 weeks, with HRT consisting of transdermal estrogen at 1.53 mg per dose, applied twice in the morning, plus oral progesterone 100 mg.
- The exercise program involved three sessions per week, two supervised by a physiotherapist and one performed at home using a Polar monitor.
- While the combination of HRT and exercise showed greater benefits for some outcomes, no significant overall effects on cardiovascular risk factors were observed.
- Exercise had a clear positive effect on fat mass, with the largest effect in the group receiving HRT plus exercise.
- However, the addition of HRT to exercise did not make a significant difference in fat-free mass.
- Menopause is accompanied by a fall in estrogen and changes in body composition, including increased fat mass and reduced lean mass, alongside insulin resistance, hypertension, and hyperlipidemia.
- The study aimed to determine whether combining exercise and HRT would have a stronger effect on insulin sensitivity and cardiovascular risk than either intervention alone.
- The study's findings suggest that a combination of HRT and exercise may offer the best outcomes for postmenopausal women seeking to improve their insulin sensitivity and overall health.
What's still developing
- "If women are worried about the side effects of HRT but are prepared to exercise, that is quite positive," she said.
- Exercise, both with and without HRT, also substantially improved physical strength and increased peak aerobic capacity.
- The once-weekly efsitora regimen "is designed to reduce injections by over 300 per year versus once-daily basal insulin," Lilly reported in a news release.
- All trials showed safety profiles of efsitora that were similar to the basal insulin comparators.
- In the most recent QWINT-1 trial, published in the New England Journal of Medicine, the fixed-dose regimen of efsitora in patients with T2D who had not been previously treated with insulin was comparable to once-daily glargine, with notable reductions in clinically significant or severe hypoglycemia (rate ratio, 0.57).
- "This straightforward fixed-dose regimen of once-weekly efsitora, which mimics the approach used for once-weekly incretin-based therapies, may simplify treatment and lead to a lower injection burden than that with the traditional sliding-scale dose adjustments of once-daily insulin therapies," the authors wrote.
- That being said, "there is still a niche for long-acting insulin, particularly in those individuals who have little or no residual insulin secretion and have longstanding T2D," he concluded.
- The FDA has approved the once-weekly injectable basal insulin drug insulin efsitora alfa-gobe (Onswik, Eli Lilly) for use as an adjunct with diet and exercise to help control blood sugar in adults with type 2 diabetes (T2D).
- The action marks the second such FDA approval for a long-acting, once-weekly insulin, following the March approval of Novo Nordisk's competing insulin icodec-abae (Awiqli).
- Efsitora, with a fixed-dose regimen delivering steady basal insulin levels over 7 days, is expected to be available in the US in coming months in prefilled pens with two concentrations — U-500 (500 units/mL), delivering a maximum of 400 units per single injection, and U-1000 (1000 units/mL), delivering a maximum of 800 units per injection.
- The FDA approval was supported by evidence from the phase 3 QWINT clinical trial program, involving more than 3400 adults with T2D in four international trials, showing noninferiority of efsitora in comparison with once-daily insulin glargine U-100 and with insulin degludec U-100 in the reduction of A1c from baseline.
- Eli Lilly said the once-weekly dosing schedule is designed to reduce injections by more than 300 per year compared with once-daily basal insulin treatments.