Genitourinary syndrome of menopause significantly affects the quality of life in postmenopausal women with few evidence-based alternatives to vaginal estrogen for women with contraindications. This systematic review evaluates the evidence for vaginal vitamin E efficacy in reducing patient-reported genitourinary symptoms in healthy postmenopausal women compared to placebo or vaginal control therapy. This systematic review evaluated randomized controlled trials before October 2020 that assessed the efficacy of vitamin E vaginal suppositories in reducing genitourinary symptoms in postmenopausal women compared with a control group of healthy postmenopausal women. Outcomes included patient-perceived genitourinary symptoms. Of the 31 studies, four met the inclusion criteria. One 8-week trial (n = 42) found a significant reduction in vaginal symptoms in the 1 mg vitamin E group than the placebo group (difference in means, 5.3; 95% confidence interval [CI], 4.4 to 6.2). Another 8-week trial (n = 40) found 5 mg vaginal hyaluronic acid superior to 1 mg vitamin E (difference in means -0.50, 95% CI, -0.95 to -0.05). Two 12-week trials (n = 52 in each) found no difference between 0.5 g vaginal estrogen and 100 IU vaginal vitamin E in healthy postmenopausal women (difference in means: -0.19, 95% CI, -4.4 to 4.0, and -3.47, 95% CI, -13.8 to 6.8). Evidence from small, limited studies suggests that vaginal vitamin E may be effective in alleviating symptoms of genitourinary syndrome of menopause; however, additional high-quality studies are needed to determine efficacy, ideal dosing, and long-term safety.

patients newly diagnosed with diabetes compared with oral hypoglycemic agents on b-cell function and diabetes remission rate. 2 Patients with an HbA1c of 9.5% to 9.8% were enrolled in the study and randomly assigned to one of three groups: continuous subcutaneous insulin infusion (CSII), multiple daily injections (MDI), or oral hypoglycemic agents (OHA). In both insulin groups, the total daily dose of insulin was 0.4 to 0.5 IU/kg-50% basal and 50% bolus doses in the insulin infusion group, and 30% to 20%, and 30%, 20%, 20% pre-meal, and 30% nighttime insulin in the MDI group. The oral hypoglycemic group, with body mass index (BMI) 20 to 25 kg/m 2 , was initially treated with gliclazide 80 mg twice a day and titrated up to a maximum dose of 160 mg twice a day to achieve glycemic control. Those with BMI 25 to 35 kg/m 2 were initially treated with metformin 500 mg twice a day and titrated up to a maximum dose of 2,000 mg daily. A combination of gliclazide and metformin was used in patients who could not reach the glycemic control goal with one oral agent or who had HbA1c .8.6%. More patients achieved glycemic control (HbA1c #8.0%) in the insulin groups (97.1% in CSII and 95.2% in MDI) in less time (4.0 days with infusion and 5.6 days with multiple daily injections) than those treated with oral agents (82.6% in 9.3 days; P,.0001 vs infusion and P5.01 vs multiple injections). Remission rates, defined as patients postintervention who maintained optimum glycemic control (fasting plasma glucose ,90 mg/dL, and 2hour postprandial glucose ,180 mg/dL) for at least 12 months without medication, were significantly higher in insulin groups (51.1% and 44.9% in CSII and MDI, respectively) than in the oral agent group (26.7%; P5.0012). This clinical trial was used in the meta-analysis above, however, was included here because it detailed the difference in outcomes between the two groups: insulin therapies compared with oral agents.Since 2013, the American Academy of Clinical Endocrinologists and American College of Endocrinology have periodically released recommendations for comprehensive management of patients with type 2 diabetes. 3 For newly diagnosed patients with HbA1c .9.0% (.11.7 mmol/L) who are symptomatic (presenting with polyuria, polydipsia, or polyphagia), the 2020 update recommended initiation of insulin with or without additional diabetes medication.