The British Journal of Diabetes & Vascular Disease current issue

Influences of excess adiposity on reproductive function

Mahmood, T. A — Wed, 21 Oct 2009 07:39:51 PDT

Review: Diabetes and pregnancy: a review of pathology

Evans, M. J — Wed, 21 Oct 2009 07:40:40 PDT

Diabetes in pregnancy is associated with increased foetal morbidity and mortality. This article describes and reviews specific features of the placenta and the foetal anomalies seen in association with diabetes and briefly considers potential underlying mechanisms.

Review: Diabetes in pregnancy: insulin resistance, obesity and placental dysfunction

Doshani, A., Konje, J. C — Wed, 21 Oct 2009 07:40:58 PDT

Obesity in pregnancy is linked to increased morbidity and mortality for mother and baby. The incidence of gestational diabetes is increased approximately two to six-fold in women who are overweight-obese and the presence of diabetes is a further metabolic challenge which is associated with adverse outcomes. Herein the role of obesity is discussed in the generation of insulin resistance and inflammation and its contribution to placental dysfunction.

Review: Androgens, erectile dysfunction and cardiovascular risk in type 2 diabetes

Hackett, G. I — Wed, 21 Oct 2009 07:41:04 PDT

Men with type 2 diabetes now require annual assessment for erectile dysfunction, and this should include assessment for testosterone deficiency. Up to 40% of patients might be candidates for testosterone replacement for the treatment of bothersome symptoms including erectile dysfunction, lethargy, fatigue, loss of libido and depressed mood. There is emerging evidence that there may also be benefits in the primary care quality parameters for type 2 diabetes.

Metformin treatment for gestational diabetes

Hyer, S. L, Balani, J., Johnson, A., Shehata, H. — Wed, 21 Oct 2009 07:41:09 PDT

The prevalence of gestational diabetes mellitus (GDM) is rising as the pregnant population becomes older and more obese. This is concerning because GDM is associated with increased perinatal morbidity such as macrosomia and shoulder dystocia, and the need for instrumental delivery. In addition, the offspring of GDM women have increased long-term risks of obesity and type 2 diabetes. There is no doubt that treating women with GDM improves pregnancy outcomes. Conventionally this has been by diet and insulin. Although effective, insulin increases appetite leading to weight gain. It increases the risk of hypoglycaemia and needs to be given by injection. There is also a substantial cost in terms of time for teaching and educating patients. Metformin offers a logical alternative to insulin in GDM, by reducing insulin resistance. Recent trial evidence indicates it is safe and effective. We describe our experience with metformin in GDM and review the evidence.

Biochemical hypogonadism in men with type 2 diabetes in primary care practice

Wed, 21 Oct 2009 07:41:10 PDT

Objective:

This study explores the links between testosterone deficiency and Quality Outcomes Framework (QOF) parameters in three south Staffordshire practices prior to a major double-blind placebo-controlled intervention study. Research design and methods:

Four hundred and eighty-eight consecutive type 2 diabetic patients, aged over 18, attending their general practitioner for routine diabetes visits were assessed for sex hormone binding globulin, total testosterone (TT), calculated free testosterone (FT) and bioavailable testosterone, glycated haemoglobin A1c (HbA1c), body mass index, waist circumference, blood pressure, lipid profile, Sexual Health Inventory for Men, and current and past prescriptions for erectile dysfunction (ED).

Results:

TT and FT were significantly inversely associated with raised body mass index, waist circumference and HbA1C. The prevalence of ED was 77%, which was associated with low levels of TT, FT and raised HbA1C. Only 10% were receiving treatment for ED.

Conclusions:

Patients with low testosterone were more likely to fall outside the QOF targets and new markers might be difficult to achieve unless low testosterone is addressed. There is a strong case for the inclusion of TT and FT estimation in routine diabetic care.

Metformin: an important tool for endocrinology in the West Indies. New tricks for an old drug

Teelucksingh, S., Pinto Pereira, L. M — Wed, 21 Oct 2009 07:41:11 PDT

Against the backdrop of an obesity pandemic, comes an increasing prevalence of metabolic (e.g. type 2 diabetes mellitus) and reproductive abnormalities (e.g. polycystic ovarian syndrome) mediated by the phenomenon of insulin resistance. Metformin is an inexpensive and widely available drug which partly through an insulin sensitising action has an antidiabetic action with unique cardioprotective effects and which has value in preventing progression of pre-diabetes to diabetes. Despite mounting favourable data its role in polycystic ovarian syndrome remains unsettled. The recent finding for its safety and efficacy in gestational diabetes, however, will no doubt lift concerns over its use in women in the reproductive age group. One immediate result would be its earlier and greater therapeutic application in under-resourced environments where cost and emotional barriers to insulin exist.

Male obesity: impact on fertility

Kay, V. J, Barratt, C. L R — Wed, 21 Oct 2009 07:41:12 PDT

Obesity has been shown to adversely affect male fertility, by reducing spermatogenesis. There are several aetiological theories including endocrine abnormalities, genetic, sexual dysfunction and testicular hyperthermia. Of these, endocrine abnormalities are likely to be the most important, involving increased oestrogen and increased insulin resistance, reduced androgens and reduced inhibin B levels. Possible management options include weight reduction by dieting or surgery and medical treatment to correct specific endocrine abnormalities, but as yet none has been proven to be effective.

The results of gastric bypass surgery in a teenager

Teelucksingh, S., Dan, D. — Wed, 21 Oct 2009 07:41:12 PDT