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Fournier’s gangrene & SGLT2i – how rare is it?

23rd March 2019, Dr Chee L Khoo

You may remember receiving warnings recently from the Therapeutics Goods Administration (TGA) about a serious “rare” infection, called necrotising fasciitis of the perineum, also referred to as Fournier’s gangrene (FG). FG is reported to be associated with the use of SGLT2 inhibitors in patients with type 2 diabetes (T2D). The warning came on the back of similar warnings by the US Food and Drug Authority (FDA) in August 2018.…

Maintaining weight loss in primary care – is it possible?

23rd March 2018, Dr Chee L Khoo

The DiRECT trial is really a landmark study which shows that remission of type 2 diabetes (T2D) is possible with weight loss and more importantly, it can be achieved in primary care. The result from DiRECT was most impressive when published 12 months ago but the 2 burning questions on everyone’s mind were (1) Is the weight loss sustainable and (2) Is the diabetes remission maintained?” at the end of 24 months.…

Insulin-GLP1 agonist combo – two heads better than one

23rd March 2019, Dr Chee L Khoo

American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) suggest that if HbA1c targets are not achieved despite the addition of basal insulin in type 2 diabetes (T2D), treatment could also be further advanced by the addition of a glucagon-like peptide-1 receptor agonist (GLP-1 RA). The addition of a GLP1-RA has been shown to be as efficacious as the addition of a prandial insulin in patients with T2D who is not at glycaemic target despite the addition of basal insulin therapy (1).…

Diabetes management after bariatric surgery – which medication to continue

14th March 2018, Dr Chee L Khoo

Bariatric/metabolic surgery is an effective strategy to attain diabetes remission in obese patients. Significant and rapid weight loss by any means will improve insulin sensitivity, the internal glucotoxicity and lipotoxicity. Bariatric surgery, in particular, is thought to also lead to changes in gut incretins and neurotransmitters, improvement of hepatic and peripheral insulin sensitivity, altered bile acid metabolism and gut microbiota that are independent of weight loss.…

Can drugs and supplements improve sperm quality?

12th March 2019, Dr Chee L Khoo

When couples present for investigations of infertility, semen analysis is one of the earliest investigations we order. Every so often, the results come back with reduced sperm numbers, motility or normal forms. It is frustrating as a GP when we are unable to advise them what they can take to improve their sperm parameters.…

Haemorrhagic stroke – is that cerebral amyloid angiopathy?

10th March 2019, Dr Chee L Khoo

About 10% of all strokes are haemorrhagic strokes. In about 10% of cases of primary intracerebral haemorrhage (ICH), cerebral amyloid angiopathy (CAA) is regarded as a possible cause. The recurrence rate of ICH is significantly higher in patients with CAA. With improvements in MRI technology, CAA is increasingly recognised as a cause of ICH.…

Continuous glucose monitoring FREE for T1D but not FREELY available

10th March 2019, Dr Chee L Khoo

It makes sense that patients with type 1 diabetes (T1D) on insulin pump be fitted with continuous glucose monitoring (CGM) which facilitate insulin titration. It’s even better if the CGM sensor directly “talks” to the pump and adjust the basal insulin rate with an algorithm based on the blood glucose levels. There are ample studies demonstrating better glycaemic control when you use both pump and CGM for management of patients with T1D.…

The role of breast MRI in breast cancer detection

Many countries now recommend annual MRI screening in conjunction with mammography for high risk groups. The only problem is that different countries define high risk differently. Medicare item 63464 can be used for the surveillance and diagnosis of women under 50 years of age at high risk of developing breast cancer, and who have no signs or symptoms of the disease.…

Metformin in Pregnancy – first do no harm?

27th February 2019, Dr Chee L Khoo

Primum non nocere (first do no harm) is quite an appropriate term when is comes to managing pregnant women who either have dysglycaemia or are at risk of dysglycaemia. While there is no question that hyperglycaemia during pregnancy is associated with both poor maternal and foetal outcomes as well as epigenetic changes which can affect the next generation, who and how to treat is still debatable.…

How long does a knee replacement last?

23rd February 2019, Dr Chee L Khoo

Joint replacement is the mainstay treatment for advanced arthritis. Unfortunately, almost all joint replacements fail over time. We are frequently asked by patients “how long does the replacement last?”. It’s important to know how long a joint is supposed to last because it determines the “ideal” age to have the first knee replacement. Further, we can anticipate when symptoms will be coming up and start exploring the feasibility of the next joint replacement.…

Can Vitamin C reduce plasma glucose?

22nd February 2019, Dr Chee L Khoo

Increased oxidative stress appears to be a significant factor leading to insulin resistance, dyslipidaemia, β-cell dysfunction, impaired glucose tolerance and ultimately leading to type 2 diabetes (T2D). Ascorbic acid (AA) is a water soluble anti-oxidant that reduces oxidative damage at the cellular and tissue level. So, logically, AA supplementation should therefore reduce oxidate stress and lead to improvement in glycaemic control in patients with diabetes.…

Pavements and Medicare – what do they share in common?

13th February 2019, Dr Chee L Khoo

One of the great advantage of being a runner is that wherever you go, all you have to do is pack a pair of running shoes and the world is your oyster. During a recent visit to Kuala Lumpur, Malaysia, I went out running on the local streets. It was 6am and still pitch dark.…

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