First patient receives innovative new treatment to tackle combined diabetes and obesity in NHS approved trial initiated by the ABCD, UK

Main Category: Diabetes
Also Included In: Obesity / Weight Loss / Fitness
Article Date: 26 Jul 2013 - 2:00 PDT Current ratings for:
First patient receives innovative new treatment to tackle combined diabetes and obesity in NHS approved trial initiated by the ABCD, UK

Combined diabetes and obesity, 'diabesity', is a serious health problem with considerably increased risks of premature heart attack, stroke and death. If not controlled, it can also affect the eyes leading to blindness, the kidneys leading to kidney failure and the feet leading to ulcers and amputation.

The number of patients with diabesity is increasing rapidly, both in the UK and world-wide. Despite all the available expertise and best use of the most modern treatments there are many patients who remain considerably overweight and with poor diabetes control, rendering them vulnerable to these complications.

For such patients a possible new treatment has become available. It is called endobarrier and consists of a 60cm tube-like liner made from a thin, flexible and durable impermeable polymer. It is inserted by the simple procedure of endoscopy and is anchored in place, just beyond the stomach, by a basket of very thin wire made of Nitinol-an alloy of nickel and titanium. The endobarrier prevents food from contacting the first two feet of small intestine and this leads to considerable weight loss (18% reduction) and improvement in diabetes control (87% of patients reach the target control level).

Because this treatment could well be just what is needed for the patients who remain in trouble from their diabetes despite the best treatments available, ABCD have initiated a national trial of the new device funded by a grant from their Diabetes Care Trust (ABCD ) Registered Charity Number 1139057. The study is supported by the NHS and is centred at Birmingham's City Hospital with supporting centres in London (King's College Hospital and Guy's and St Thomas' Hospitals) and Glasgow (Glasgow Royal Infirmary).

Dr Piya Sen Gupta, ABCD Research Fellow, who is conducting the study for ABCD, said: "This trial presents an exciting opportunity for patients with combined diabetes and weight problems, who currently have limited treatment options, to kick start their way back to health.

"It is a novel idea to use a device to treat diabesity when the usual medications have failed and it may offer a valuable treatment option, avoiding in some, the need for invasive bariatric surgery. By opening this study up to NHS patients in Birmingham, London and Glasgow, the results will be relevant throughout the UK. This study has been so named, as we do hope that it goes some way to REVISE-Diabesity"

The first patient to receive the new treatment in the trial is due to have her device inserted on the morning of Thursday 25th July, 2013, at Birmingham's City Hospital.

ABCD Chairman, Dr Chris Walton, said :"The twin epidemics of obesity and diabetes may bankrupt our healthcare systems. The projected spend on diabetes rises from the current 10% of NHS expenditure to 17% of NHS expenditure by 2035 and it is estimated that, for type 2 diabetes, the cost of complications of the disease is more than threefold the cost of treatment. ABCD is keen to research new technologies that confront obesity in diabetes and which may prevent the relentless progress to complications, so the placement of the first endobarrier device in this study is a landmark date''

Dr Bob Ryder, Principal Investigator for the ABCD study, said: "At the moment we have many patients who remain overweight and with poor diabetes control, despite all the available diabetes treatments. Because the endobarrier reduces weight and improves the diabetes control, it is a treatment that could break the cycle of problems for these patients who have otherwise come to the end of the line.

"The best thing about the endobarrier is that it is not permanent and after insertion at endoscopy, it is removed up to a year later, and we then have to hope that the improvement is sustained. This treatment is not currently an NHS treatment, but this is an NHS approved study, and if the trial proves successful and cost effective, we expect that the device will be considered by NICE for approval as part of mainstream NHS diabetes treatment in the future".

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our diabetes section for the latest news on this subject.

The Association of British Clinical Diabetologists (ABCD) is the national organisation of Consultant Physicians in Britain who specialise in Diabetes Mellitus. Most are also Acute General Physicians, and many are also Specialists in Endocrinology and Lipid Metabolism.

The Association of British Clinical Diabetologists (ABCD)

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posted by Dr.K.Ramakrishnan on 26 Jul 2013 at 10:12 am

Of course, the procedure is fantastic. Here some more clarifications needed. 1. Since the endobarrier is kept for one year ,is there a possibility of vital nutrient dificiency. 2. Can the procedure recommend for obesity and overwieght? 3. After one year is there any weightgain?

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'First patient receives innovative new treatment to tackle combined diabetes and obesity in NHS approved trial initiated by the ABCD, UK'

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Reproductive Outcome May Be Compromised In IVF By Female Obesity

Main Category: Fertility
Also Included In: Obesity / Weight Loss / Fitness;  Women's Health / Gynecology
Article Date: 11 Jul 2013 - 0:00 PDT Current ratings for:
Reproductive Outcome May Be Compromised In IVF By Female Obesity

An analysis of almost 10,000 first cycles of egg donation treatment at one of Europe's largest IVF centres shows that female obesity reduces the receptivity of the uterus to embryo implantation and thereby compromises reproductive outcome. The investigators report that excess female weight "impairs human reproduction" and that "the reduction of uterine receptivity is one of the mechanisms involved". As a result they advise weight reduction before pregnancy in any type of conception, including ovum donation.

The study was presented at the annual meeting of ESHRE by the Spanish gynaecologist Dr Jose Bellver from the Instituto Valenciano de Infertilidad (IVI) in Valencia, Spain.

The effect of excess body weight on female fertility has been widely studied, with most studies finding an adverse effect on outcome. The reasons, however, have been less clearly explained, with effects on cycle regularity and ovulation the most frequently cited.(1) The presence of polycystic ovary syndrome, for example, the most common hormonal reproductive disorder, is regulated in part by body weight.

The study was a review of 9587 egg donation treatments performed at three IVI clinics in Spain between 2000 and 2011. All the egg donors were of normal weight, so their body weight could not confound the results. Egg recipients, however, were of varying body weights, and divided into four groups: lean with BMI below 20 kg/m2 (1458 patients, 15.2%), normal with BMI 20-24.9 kg/m2 (5706 patients, 59.5%), overweight with BMI 25-29.9 kg/m2 (1770 patients, 18.5%), and obese with BMI >=30 kg/m2 (653 patients, 6.8%).

When the outcome of the treatment was cross-checked against the BMI of the egg recipient, results showed that the rates of embryo implantation, pregnancy, twin pregnancy and live birth were all significantly reduced as BMI increased.

For example, live birth rate in the four groups was 38.6% in the lean underweight, 37.9% in the normal weight, 34.9% in the overweight, and 27.7% in the obese. Similarly, the rate of embryo implantation in the uterus was 40.4% in the lean underweight, 39.9% in the normal weight, 38.5% in the overweight, and 30.9% in the obese. These trends translated to a statistically significant 27% lower risk of live birth for an obese patient than for one of normal weight (relative risk 0.73).

The investigators acknowledge that there are possible confounding factors in the study (notably that maternal health information was incomplete in the second and third trimesters of pregnancy), but the design of this large study in a series of egg donation treatments ruled out any possibility that the weight of the egg donor (all defined as of normal weight) could affect results in the recipient. The lower level of implantation with increasing BMI suggests an unequivocal effect of recipient BMI.

"Based on our results, the chance of having a baby by egg donation is reduced by around one third for obese women," said Dr Bellver. "More specifically, we found that obese recipients of eggs from normal weight donors had a 23% lower implantation rate than normal weight recipients, 19% lower clinical pregnancy rate, and 27% lower live birth rate."

He explained that, as a systemic disease, obesity "probably affects the different components of the reproductive system independently". For example, some common pathophysiological pathways, such as hyperandrogenism or insulin resistance, may be involved. In the ovary, menstrual irregularity and infertility have been described in women with weight excess.

"However," said Dr Bellver, "even in obese ovulatory women conception rates are reduced, showing that ovulation is not the only mechanism underlying this poor outcome. Oocyte and embryo quality also seem to be affected, although it is not known exactly how yet." Results of this study now suggest impaired endometrial receptivity may also contribute to the decline in fertility in obese women.

"The clinical evidence is now strong enough for implementing preconceptional health policies for obese patients considering assisted reproduction," said Dr Bellver. The control of excess weight, especially through lifestyle interventions, should be mandatory not only for improving reproductive and obstetric outcomes, but also for reducing costs derived from the greater consumption of drugs in IVF, failed treatments, maternal and neonatal complications, and metabolic and non-metabolic diseases in the offspring."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our fertility section for the latest news on this subject.

Abstract 175

Obesity and impaired uterine receptivity: clinical experience from 9,587 first cycles of ovum donation

1. Several studies have shown that female obesity reduces the live birth rate in IVF and increases the risk of miscarriage. The evidence is considered so strong in some countries (or by some clinics) that occasionally strict restrictions exist for access to fertility treatment by obese women. An explanation for the association is not fully understood, but most studies implicate an adverse effect on ovarian function and oocyte quality, with added complications from age and polycystic ovary syndrome.

European Society of Human Reproduction and Embryology

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European Society of Human Reproduction and Embryol. "Reproductive Outcome May Be Compromised In IVF By Female Obesity." Medical News Today. MediLexicon, Intl., 11 Jul. 2013. Web.
11 Jul. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Reproductive Outcome May Be Compromised In IVF By Female Obesity'

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View the original article here

Reproductive Outcome May Be Compromised In IVF By Female Obesity

Main Category: Fertility
Also Included In: Obesity / Weight Loss / Fitness;  Women's Health / Gynecology
Article Date: 11 Jul 2013 - 0:00 PDT Current ratings for:
Reproductive Outcome May Be Compromised In IVF By Female Obesity

An analysis of almost 10,000 first cycles of egg donation treatment at one of Europe's largest IVF centres shows that female obesity reduces the receptivity of the uterus to embryo implantation and thereby compromises reproductive outcome. The investigators report that excess female weight "impairs human reproduction" and that "the reduction of uterine receptivity is one of the mechanisms involved". As a result they advise weight reduction before pregnancy in any type of conception, including ovum donation.

The study was presented at the annual meeting of ESHRE by the Spanish gynaecologist Dr Jose Bellver from the Instituto Valenciano de Infertilidad (IVI) in Valencia, Spain.

The effect of excess body weight on female fertility has been widely studied, with most studies finding an adverse effect on outcome. The reasons, however, have been less clearly explained, with effects on cycle regularity and ovulation the most frequently cited.(1) The presence of polycystic ovary syndrome, for example, the most common hormonal reproductive disorder, is regulated in part by body weight.

The study was a review of 9587 egg donation treatments performed at three IVI clinics in Spain between 2000 and 2011. All the egg donors were of normal weight, so their body weight could not confound the results. Egg recipients, however, were of varying body weights, and divided into four groups: lean with BMI below 20 kg/m2 (1458 patients, 15.2%), normal with BMI 20-24.9 kg/m2 (5706 patients, 59.5%), overweight with BMI 25-29.9 kg/m2 (1770 patients, 18.5%), and obese with BMI >=30 kg/m2 (653 patients, 6.8%).

When the outcome of the treatment was cross-checked against the BMI of the egg recipient, results showed that the rates of embryo implantation, pregnancy, twin pregnancy and live birth were all significantly reduced as BMI increased.

For example, live birth rate in the four groups was 38.6% in the lean underweight, 37.9% in the normal weight, 34.9% in the overweight, and 27.7% in the obese. Similarly, the rate of embryo implantation in the uterus was 40.4% in the lean underweight, 39.9% in the normal weight, 38.5% in the overweight, and 30.9% in the obese. These trends translated to a statistically significant 27% lower risk of live birth for an obese patient than for one of normal weight (relative risk 0.73).

The investigators acknowledge that there are possible confounding factors in the study (notably that maternal health information was incomplete in the second and third trimesters of pregnancy), but the design of this large study in a series of egg donation treatments ruled out any possibility that the weight of the egg donor (all defined as of normal weight) could affect results in the recipient. The lower level of implantation with increasing BMI suggests an unequivocal effect of recipient BMI.

"Based on our results, the chance of having a baby by egg donation is reduced by around one third for obese women," said Dr Bellver. "More specifically, we found that obese recipients of eggs from normal weight donors had a 23% lower implantation rate than normal weight recipients, 19% lower clinical pregnancy rate, and 27% lower live birth rate."

He explained that, as a systemic disease, obesity "probably affects the different components of the reproductive system independently". For example, some common pathophysiological pathways, such as hyperandrogenism or insulin resistance, may be involved. In the ovary, menstrual irregularity and infertility have been described in women with weight excess.

"However," said Dr Bellver, "even in obese ovulatory women conception rates are reduced, showing that ovulation is not the only mechanism underlying this poor outcome. Oocyte and embryo quality also seem to be affected, although it is not known exactly how yet." Results of this study now suggest impaired endometrial receptivity may also contribute to the decline in fertility in obese women.

"The clinical evidence is now strong enough for implementing preconceptional health policies for obese patients considering assisted reproduction," said Dr Bellver. The control of excess weight, especially through lifestyle interventions, should be mandatory not only for improving reproductive and obstetric outcomes, but also for reducing costs derived from the greater consumption of drugs in IVF, failed treatments, maternal and neonatal complications, and metabolic and non-metabolic diseases in the offspring."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our fertility section for the latest news on this subject.

Abstract 175

Obesity and impaired uterine receptivity: clinical experience from 9,587 first cycles of ovum donation

1. Several studies have shown that female obesity reduces the live birth rate in IVF and increases the risk of miscarriage. The evidence is considered so strong in some countries (or by some clinics) that occasionally strict restrictions exist for access to fertility treatment by obese women. An explanation for the association is not fully understood, but most studies implicate an adverse effect on ovarian function and oocyte quality, with added complications from age and polycystic ovary syndrome.

European Society of Human Reproduction and Embryology

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

European Society of Human Reproduction and Embryol. "Reproductive Outcome May Be Compromised In IVF By Female Obesity." Medical News Today. MediLexicon, Intl., 11 Jul. 2013. Web.
11 Jul. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Reproductive Outcome May Be Compromised In IVF By Female Obesity'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here