21st April 2022, Dr Chee L Khoo
We have discussed the two-way relationship between pancreatic cancer and diabetes. Patients with type 2 diabetes are at 1.5-2.0 times higher risk of developing pancreatic ductal adenocarcinoma (PDAC). In patients with T2D, the development of PDAC destabilises glucose homeostasis pretty much in all patients with T2D. In patients that do not have T2D, the development of PDAC pushes them across the threshold of T2D up to 6-12 months before the diagnosis.…
12th April 2022, Dr Chee L Khoo
It’s almost close to a wonder drug. It is widely used in type 2 diabetes (T2D) for management of hyperglycaemia when the HbA1c is >7.0%. For that indication, it is pretty potent and in clinical trials, can reduce the HbA1c by 1-1.5%. It also assists in weight reduction and thence, reduce the core problem of insulin resistance in these patients.…
12th April 2022, Dr Chee L Khoo
We continue to see “routine” antibiotic cover for many surgical procedures. It is not uncommon to see antibiotic prophylaxis used in major surgery like open heart surgery, joint replacement surgery and bowel surgery but the list extends to sinus surgery, routine orthopaedic surgery and not that uncommonly, plastic reconstructive surgery. This is despite international guidelines stating that for clean and clean-contaminated procedures (explicitly including any prosthetic joint arthroplasty with or without a drain, additional prophylactic antimicrobial doses should not be administered after the surgical incision is closed in the operating room.…
8th April 2022, Dr Chee L Khoo
CVD is the major cause of mortality and morbidity in patients with type 2 diabetes (T2D). There are many hundreds of cardiovascular risk prediction tools around. Well, whenever you have many versions of a particular tool, it usually tells us that none of them are particularly good in what they are meant to do – that is to predict the risk of a cardiovascular event.…
28th March 2022, Spectrum Medical Imaging
I have to admit that even I get confused as to what imaging modality is needed to assist in image guided injections. Is it ultrasound guided or is it CT guided. The table below makes the whole choice easy to follow. Image guided injections is a very effective treatment modality in patients with spinal joint related pain whether it involves facet joints in the lumbosacral or cervical spine or the root canal of the spine.…
15th March 2022, Dr Chee L Khoo
We are seeing increasing number of patients with depression. This is particularly the case over the last 2 years of the pandemic. Many of our patients were scared in the first year before the vaccines became available and confused in the second year with all sorts of news (good and bad) about the vaccines and their potential side effects.…
22nd March 2022, Dr Chee L Khoo
If you don’t already know that SGLT2 inhibitors (SGLT2i) have significant cardiovascular (and renal) benefits over and above its glucose lowering action, you better catch up with our many, many past issues at GPVoice. You should also be as familiar with the similar benefits of the GLP1 receptor agonists (GLP-1RA), especially the newer weekly injectables.…
12th March 2022, Dr Chee L Khoo
When you look at the management of patients with type 2 diabetes (T2D), almost all the patients are on a statin for both primary and secondary prevention of cardiovascular complications. I suspect that those that are not already on a statin should be on as some doctors are not aware of the tightened lipid targets in the management of patients with T2D.…
7th March 2022, Dr Chee L Khoo
We are all familiar with various fixed dose combination of glucose lowering agents. We have DDP4 inhibitors + metformin, SGLT2 inhibitors + Metformin and SGLT2 inhibitors + DPP4 inhibitors. We also have combination insulins for some time – rapid acting insulin + long acting insulin (so-called pre-mix or co-formulations). Pharmacologically, they make sense as these combined agents either work via different mechanisms or have different pharmacokinetics.…
6th March 2022, Dr Chee L Khoo
This is about the potential cardiovascular complications after contracting covid-19 infection. It is coined “the Covid Heart”. A recent analysis of data from 154,000 US veterans one year out from their covid-19 infection have highlighted some scarry statistics. Naturally, you would expect that those who had more severe disease had higher risks of cardiovascular complications but these complications affect patients who are not hospitalised.…
27th February 2022, Dr Chee L Khoo
Homozygous familial hypercholesterolaemia (HoFH) is one of those conditions that allow us to prescribe the new PCSK9 inhibitors under PBS Authority. It is a pretty rare inherited disorder resulting in extremely elevated low-density lipoprotein cholesterol (LDL) levels and significantly elevated risk of premature atherosclerotic cardiovascular disease (ASCVD). Despite the extreme high risks, HoFH is usually go unrecognised and if recognised are diagnosed late and undertreated.…
26th February 2022, Dr Chee L Khoo
We all know that, in theory, exercises are always good for our patients with type 2 diabetes (T2D) in more ways than one. There are a few problems though, when putting theory into practice. Most of our patients with T2D not only don’t exercise regularly, they actually don’t know what exercise to do, how they should do it for and how often they are supposed to be doing them.…