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Archive for the ‘Diabetes’ Category

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BMJ  2007;335:663-666 (29 September).

Managing anovulatory infertility and polycystic ovary syndrome

BY: Adam H Balen, professor of reproductive medicine and surgery, Anthony J Rutherford, consultant in reproductive medicine and surgery.

Summary points

  • Polycystic ovary syndrome is the most common endocrine problem affecting women and the most common cause of anovulatory infertility
  • Oral clomifene citrate remains the first line treatment to induce ovulation
  • Gonadotrophin treatment needs careful monitoring to reduce risk of multiple pregnancy
  • Despite early promise, the role of metformin and insulin lowering agents is unclear in the management of anovulatory polycystic ovary syndrome

Anovulation is the cause of infertility in about a third of couples attending infertility clinics, and polycystic ovary syndrome accounts for 90% of such cases.

The definition of polycystic ovary syndrome recognises obesity as an association and not a diagnostic criterion. Only 40-50% of women with the syndrome are overweight.

Obesity has a profound effect on both natural and assisted conception—it influences the chance of becoming pregnant and the likelihood of a healthy pregnancy. Obesity is associated with increased rates of congenital anomalies (neural tube defects and cardiac defects), miscarriage, gestational diabetes, hypertension, problems during delivery, stillbirth, and maternal mortality.

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BMJ  2007;335:638 (29 September). 

We know that regular exercise can help people with type 2 diabetes achieve better glycaemic control. Aerobic activities such as cycling or resistance training with weights can bring down serum concentrations of glycated haemoglobin.

But these activities are even more effective when combined, according to a randomised trial. Participants exercised three times a week for six months.

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BMJ 2007;335:223 (4 August) by Janice Hopkins Tanne.

Rosiglitazone (Avandia) and pioglitazone (Actos) DOUBLED the risk of heart failure in patients with type 2 diabetes (Diabetes Care 2007;30:2148-53).

The authors said that although drugs in the thiazolidinedione class were known to increase the risk of heart failure in patients with type 2 diabetes, the magnitude of the risk had not been evaluated.

One in every 50 patients with type 2 diabetes taking one of these drugs would develop heart failure in a period of 26 months and need admission to hospital.

Heart failure occurred at low and high doses of the drugs and among people younger than 60 years as well as among older people.

The author, said this is nothing NEW, but it is still something very worthwhile to know for GP’s.

If you want to read the extract just CLICK HERE.

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