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Regensburg, Germany

Bals-Pratsch M.,Center for Reproductive Medicine | Grosser B.,Practice for Endocrinology | Seifert B.,Center for Reproductive Medicine | Ortmann O.,University of Regensburg | Seifarth C.,Practice for Endocrinology
Experimental and Clinical Endocrinology and Diabetes | Year: 2011

Objectives: Polycystic ovary syndrome (PCOS) and/or insulin resistance (IR) are frequent conditions in women choosing assisted reproduction techniques (ART). However, infertility work-up has to include testing of insulin sensitivity to diagnose IR. It was the aim of the study to analyze the frequency of impaired glucose tolerance (IGT) or gestational diabetes (GD) in the first weeks of gestation after ART in women receiving metformin. Design and Methods: This study included 107 women who were seeking ART under the pretreatment of metformin for PCOS, confirmed IR, recurrent spontaneous miscarriages (RSA) or other fertility disorders. They were examined for prepregnancy health parameters (weight, glucose tolerance). When pregnancy was confirmed a 75g oral glucose tolerance test (OGTT) was conducted between the 5th and 7 th week of gestation. Results: A high rate of GD or IGT already was observed in the first weeks of pregnancy in our cohort under metformin treatment. The predominant risk factor for diagnosed early onset of IGT or GD (58 cases) was PCOS (p=0.014). The frequency of GD was the highest in the subgroup with prepregnancy confirmed IR not fulfilling the criteria of PCOS (55%); it was 40.6% in PCOS women and 26.1% in women neither exhibiting IR nor PCOS. Conclusions: Women seeking ART and being treated with metformin still show a very high rate of GD or IGT after achieving pregnancy by ART. Therefore in women undergoing ART screening for GD should be performed as soon as pregnancy is confirmed to avoid miscarriages due to overlooked uncontrolled glucose metabolism. © Georg Thieme Verlag KG Stuttgart - New York.

Strasburger C.J.,Charite - Medical University of Berlin | Karavitaki N.,Oxford Center for Diabetes Endocrinology and Metabolism | Stormann S.,Ludwig Maximilians University of Munich | Trainer P.J.,Christie | And 12 more authors.
European Journal of Endocrinology | Year: 2016

Background: Long-acting somatostatin analogues delivered parenterally are the most widely used medical treatment in acromegaly. This patient-reported outcomes survey was designed to assess the impact of chronic injections on subjects with acromegaly. Methods: The survey was conducted in nine pituitary centres in Germany, UK and The Netherlands. The questionnaire was developed by endocrinologists and covered aspects of acromegaly symptoms, injection-related manifestations, emotional and daily life impact, treatment satisfaction and unmet medical needs. Results: In total, 195 patients participated, of which 112 (57%) were on octreotide (Sandostatin LAR) and 83 (43%) on lanreotide (Somatuline Depot). The majority (O70%) of patients reported acromegaly symptoms despite treatment. A total of 52% of patients reported that their symptoms worsen towards the end of the dosing interval. Administration site pain lasting up to a week following injection was the most frequently reported injection-related symptom (70% of patients). Other injection site reactions included nodules (38%), swelling (28%), bruising (16%), scar tissue (8%) and inflammation (7%). Injection burden was similar between octreotide and lanreotide. Only a minority of patients received injections at home (17%) and5% were self-injecting. Over a third of patients indicated a feeling of loss of independence due to the injections, and 16% reported repeated work loss days. Despite the physical, emotional and daily life impact of injections, patients were satisfied with their treatment, yet reported that modifications that would offer major improvement over current care would be 'avoiding injections' and 'better symptom control'. Conclusion: Lifelong injections of long-acting somatostatin analogues have significant burden on the functioning, well-being and daily lives of patients with acromegaly. © 2016 European Society of Endocrinology Printed in Great Britain.

Seifarth C.,Practice for Endocrinology | Schehler B.,Practice for Endocrinology | Schneider H.J.,Ludwig Maximilians University of Munich
Experimental and Clinical Endocrinology and Diabetes | Year: 2013

Objective: The efficacy of metformin for the treatment of obesity has been evaluated in few clinical trials with inconclusive results. Moreover, the effectiveness in a real-life outpatient setting has not been tested until today. In this study we aimed to examine the effectiveness of metformin as a weight reducing drug in obese and overweight patients with regard to their degree of insulin resistance. Design and patients: We treated 154 consecutive patients with a body mass index 27kg/m2 in an outpatient setting over 6 months with metformin up to a dosage of 2500mg per day. Additionally, we included 45 untreated patients as controls. Patients were monitored for weight changes over 6 months. Before metformin treatment was started insulin sensitivity was determined in all patients by calculating HOMA index and Matsuda index after a 75g oral glucose tolerance test. Results: The mean weight loss in the metformin treated group was 5.8±7.0kg (5.6±6.5%). Untreated controls gained 0.8±3.5kg (0.8±3.7%) on average. Patients with severe insulin resistance lost significantly more weight as compared to insulin sensitive patients. The percentage of weight loss was independent of age, sex or BMI. Conclusion: Metformin is an effective drug to reduce weight in a naturalistic outpatient setting in insulin sensitive and insulin resistant overweight and obese patients. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.

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