Oral therapy in type 2 diabetes – navigating the PBS maze

14th November 2019, Dr Chee L Khoo

Oral therapy for T2D – navigating the PBS maze

During our recent GP Diabetes Injectable Masterclass Workshop, I noted that there was a lot of uncertainty and confusion in relation to what oral agents can be combined under the PBS. This uncertainty and confusion can only lead to hesitation to escalate treatment in patients whose glycaemic control is suboptimal.…

The complexity of managing T2D – a GP’s perspective

13th November 2019, Drs Chee Khoo & Sobhy Khalil

We have a contribution from our GP colleague this week. Dr Sobhy Hakeem KHALIL who thoroughly studied the ADA/EASD Management of Hyperglycaemia In Type 2 Diabetes, 2018 Consensus Report and provided his take on the guidelines. I have added my comments to his take (in blue):

  1. They emphasised the importance of life style changes such as weight reduction, physical activities (aerobic and high resistance activities) and smoking cessation.

Prostate Artery Embolisation

PAE is an embolisation procedure. It is a new application of a longstanding tried and tested technology. Embolisation is the deliberate occlusion of vessels in the body, in this case the arteries to the prostate.  The objective of PAE is to stem the blood flow to the prostate, targeting the enlarging tissue and rendering it ischaemic (reduced supply of oxygenated blood).…

Second generation basal insulins – are they truly better insulins?

27th October 2019. Dr Chee L Khoo

In medicine, newer is usually better although sometimes, we can be sceptical whether “newer” means a sneaky way to extend patents. The newer, second generation insulins, Toujeo® (insulin glargine U300 or GLA-300)  and Degludec® are truly better insulins. Diabetes Therapy recently published a practical guide to the use of these second generation insulins (1).…

Percutaneous Coronary Intervention after STEMI – stent one or stent all?

27th October 2019. Dr Chee L Khoo

Imagine you are the interventional cardiologist. You are asked to perform a percutaneous coronary intervention for a symptomatic coronary artery stenosis with a view of inserting a stent for the tight stenotic lesion. As the coronary angiogram is being performed, you discover that there are more than one stenotic lesion. Do you stent the symptomatic lesion alone as was originally intended or do you stent all the other incidentally found stenotic lesions?…

Does bariatric surgery reduce major adverse cardiovascular events?

27th October 2019. Dr Chee L Khoo

We often hear about cardiovascular outcomes trials (COVT) involving the new anti-diabetic agents – the SGLT2 inhibitors, the DPP4 inhibitors and the GLP1-RAs. The CVOTs were meant to ensure that the agents do not have significant major adverse cardiovascular outcomes (MACE) when we prescribed them for patients with type 2 diabetes (T2D). All make sense as we need to make sure that post Phase 2 trials when these agents are used in hundreds of thousands of patients, they don’t cause more harm that good.…

Nut consumption and weight change – is it positive or negative?

11th October 2019. Dr Chee L Khoo

We all know that weight management is not as simple as a calories in calories out equation. Increasing nut consumption in particular, in theory, can cause weight gain because of nuts’ energy density but it doesn’t always translate to weight gain. In fact, a recent study showed the opposite – increased nut consumption actually is associated with reduced long term weight gain.…

Anti-coagulant related nephropathy – do you know who is at risk?

6th October 2019. Dr Chee L Khoo

Traditionally, warfarin was the main anticoagulant for stroke prevention in patients with atrial fibrillation and in patients with significant valvular disease. The newer direct oral anti-coagulants (DOACs) are now the main anti-coagulants used instead of warfarin. However, a common limiting factor in the use of the DOACs is renal impairment. We still have come back to good old warfarin in patients whose eGFR is near 30 mL/min/1.73 m2.…

Pancreatic cancer and T2D – how are they related?

6th October 2019. Dr Chee L Khoo

Last month we looked at the state of play with screening for the deadly disease, pancreatic ductal adenocarcinoma (PDAC). We saw how it may not be useful to screen the general population with the technology that we have but there are select higher risk groups where screening may be useful. Long standing type 2 diabetes (T2DM) is a modest risk factor for PDAC.…

Oral failure in T2D – what’s next?

28th September 2019. Dr Chee L Khoo

I have known Greg for about 30 years. He is now 63 years old and has amongst many medical conditions, type 2 diabetes (T2D). He is a working class telephony technician. I have seen him and his children grown up. They are now adult kids but Greg, like the usual middle aged Australian, has gradually grown fatter and less healthy over the years.…

Diagnosis of breast invasive ductal carcinoma – a case study

26th September 2019. Spectrum Medical Imaging

Breast cancer is the most common cancer affecting women. In 2019, it is estimated that 19,535 Australians will be diagnosed with breast cancer. However it is important to remember that most women survive breast cancer. Diagnosis of breast cancer patients in early stages is one of important aspects of breast cancer treatment. Among of many diagnostic platforms, imaging techniques are main diagnostic approaches which could provide valuable data on patients with breast cancer.…