T2D remission: can it happen in real world in primary care?

11th February 2024, A/Prof Chee L Khoo

Significant weight loss of >10% body weight has been associated with remission of type 2 diabetes. It’s not surprising, really, is it? The DiRECT trial which reported in 2018 demonstrated that early in T2D, significant weight loss can lead to remission of T2D (1). Importantly, DiRECT showed that weight loss of >10% can be achieved in primary with minimal support.…

Hypertriglyceridaemia – the forgotten villain?

11th February 2024, A/Prof Chee L Khoo


Hypertriglyceridaemia (HTG) often accompanies hypercholesterolaemia but that is often ignored as it is considered to be a minor villain. Older clinical trials on lipid lowering agents excluded subjects with HTG and that is partly why the significance of HTG is often ignored. The interplay between HTG and atherosclerotic cardiovascular disease (ASCVD) is real but extremely complicated.…

Weekly insulin and weekly GLP1-RA – ideal partners?

27th January 2024, A/Prof Chee L Khoo

Weekly combo

We are all pretty much used to weekly GLP1-RA injections for our patients with type 2 diabetes (T2D). Certainly, a lot less needles compared with the once daily or twice daily GLP1-RA injections and therefore more acceptable to patients (including those without diabetes!). Weekly GLP-1 are efficacious in reducing fasting as well as postprandial glucose.…

Marathon running – putting science into practice

27th December 2023, A/Prof Chee L Khoo

Endurance athlete

When we think about extreme physical activity (EPA) such as marathon running, apart from the perceived issue of wearing out knee and hip joints (that’s another issue, another day), we think about the cardiovascular risks or benefits that comes with this intense physical activity. We explored the issue of marathon running and cardiovascular risks 9 months ago here.…

CKD in T1D – any advances in management?

27th December 2023, A/Prof Chee L Khoo


Not surprisingly, if dysglycaemia is the major contributor to microvascular complications in type 2 diabetes (T2D), the same complications must plaque our patients with type 1 diabetes (T1D. However, we haven’t had many major advances in the management for chronic kidney disease (CKD) and cardiovascular disease (CVD) in patients with T1D for decades.…

GLP1RAs – do they reduce CV events?

14th November 2023, A/Prof Chee L Khoo

Cardiovascular Events

Obesity is a recognised risk factor for cardiovascular disease (CVD). We are all used to treating cardiovascular risk factors such as hypertension, dyslipidaemia and diabetes in an attempt to reduce CV events. We should also treat the obesity, shouldn’t we? Logically, weight reduction should lead to reduction in CV events but, unfortunately, lifestyle changes and pharmacological interventions to reduce obesity have not been shown to improve cardiovascular outcomes (1-5).…

Precision medicine in diabetes – are we there yet?

30th October 2023, Dr Chee L Khoo


When we think about precision medicine, we usually think about some fancy, expensive genetic tests that can help us determine ahead of time who is at risk of some serious diseases. This may allow us to target these patients early and reduce morbidity and mortality. There is connotation that only the rich in rich countries can afford these tests and once again, patients in low and middle income countries (LMIC) will miss out on these state of the art expensive tests.…

MAFLD to MASLD – another name change again?

28th October 2023, A/Prof Chee L Khoo


It’s all deja-vu again. In January, we discussed the name change from NAFLD to MAFLD. We also discussed how the metabolic dysfunction fatty liver disease (MAFLD) nomenclature and definition were not quite universally accepted internationally. Somehow, we knew that MAFLD was really a temporary placeholder. And indeed, it was and many international bodies have got together since then and put together a consensus nomenclature for metabolic dysfunction associated steatotic liver disease or MASLD (pronounced MASL-D).…

Tirzepatide is finally here – what’s the big deal?

28th September 2023, Dr Chee L Khoo

Five years ago, we previewed the arrival of the twincretins. These are agents which contain both incretins, GLP1 and GIP. Back then, agent LY3298176 was shown to cause significant weight loss and reduction in glucose. Two years ago, agent LY3298176 finally had a name – tirzepatide. Two years ago, we looked briefly at the clinical trials comparing tirzepatide with various glucose lowering agents.…

HFpEF – does semaglutide help?

12th September 2023, Dr Chee L Khoo


We have a number of drug classes that are helpful in reducing mortality in patients with heart failure with reduced ejection fraction. But when it comes to heart failure with preserved ejection fraction, SGLT2 inhibitors are the only class that have shown to be of use. ARNI, MRA or betablockers helps with HFrEF but in HFpEF?…

Dorzagliatin can induce diabetes remission – what is it?

13th August 2023, Dr Chee L Khoo

Over the last 2 decades we have seen a number of new classes of glucose-lowering agents in the management of patients with type 2 diabetes (T2D). It was quite a few years after the introduction of the thiazolidinediones (pio- and rosiglitazones) that the DPP4 inhibitors, the GLP1- RA and then SGLT2 inhibitors came along and now changed the way we manage T2D.…

Heart Failure – are biomarkers useful?

12th July 2023, Dr Chee L Khoo

The WHO define biological markers or biomarkers as “any substance, structure or process that can be measured in the body or its products and influence or predict the incidence of outcome or disease”. In heart failure, many biomarkers have been studied but B-type natriuretic peptide (BNP) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) come close to the characteristics of “ideal” heart failure (HF) biomarkers.…