Menopause and Diabetes: A health-data study to investigate the role of health inequalities

The transition into menopause and the associated gradual loss of oestrogen can affect blood glucose control. There is some evidence from small clinical trials that the use of Hormone Replacement Therapy (HRT) can mitigate the excess risk of uncontrolled blood glucose levels. As identified by Diabetes UK, evidence remains inconclusive. We propose a series of population-based studies using routinely collected UK primary care data (2004-2024) to: Assess changes in the occurrence rate of Type-2 Diabetes Mellitus (T2DM) associated with HRT prescribing in women aged 40-65 years diagnosed with non-diabetic hyperglycemia (pre-diabetes), stratified by by age, ethnicity, socioeconomic status (SES), and body mass index (BMI); Assess changes in the incidence of acute diabetes complications (severe hypo- and hyperglycemia) and chronic diabetes complications (stroke and myocardial infarction) associated with HRT prescribing in women aged 40-65 years with Type-1 Diabetes Mellitus (T1DM) and T2DM, stratified by age, ethnicity, SES, and BMI. Our study will provide robust evidence to elucidate the role of inequalities experienced in menopause care by women with (pre)diabetes, and establish whether treatment with HRT prevents T2DM and associated complications. Findings can be used to inform strategies for the NHS Diabetes Prevention Programme to reduce the burden of T2DM in (peri)menopause.