13th April 2019, Dr Chee L Khoo
SGLT2 inhibitors, as a class of anti-diabetic drugs, have been shown in multiple cardiovascular outcomes trials (EMPA-REQ, DECLARE-TIMI 58, CANVAS) to “reduce cardiovascular events in patients with type 2 diabetes (T2D)”. These are big headlines but as obsessive clinicians, we need to be more specific in the benefits of SGLT2 inhibitors in patients with T2D.…
13th April 2019, Dr Chee L Khoo
We know that overweight children have higher future risk of cardiovascular disease and diabetes. Ironically, babies who are small at birth or during infancy also have increased rates of cardiovascular disease and diabetes as adults. It is thought that foetal undernutrition at different stages of gestation are somehow link to this increased risk, but the underlying mechanism is not fully understood.…
13th April 2019, Dr Chee L Khoo
The monitoring of plasma glucose levels is crucial when we are titrating insulin doses, correlating lifestyle messages with glucose control and in detecting asymptomatic hypoglycaemia. Until now, finger-prick glucose checking is the gold standard for self-monitored blood glucose (SMBG). However, even with 7 point glucose monitoring, nocturnal hypoglycaemia may be difficult to detect.…
We read last fortnight about cerebral amyloid angiopathy (CAA). I am not sure that I can pick up a CAA when I see one. I mean, we are not experts in CT or MRI of the brain. A fairly obvious, bit chunk of an infarct is easy to spot. I can also pick up any asymmetry in the scan. Any more than that, i will have reached out to the printed report.…
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.…
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.…
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).…
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.…
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.…
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.…
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.…
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.…