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.

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).…

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.…

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.…

A patient with complex, advanced stage type 2 diabetes – where do we start?

14th September 2019. Dr Chee L Khoo

We all have patients similar to this presenting to the practice not that infrequently. This is a real case that I came across just recently. Joanne was referred to the practice by a friend of a friend. She had just been discharged from the local hospital after three weeks following amputation of the lateral two toes of her right foot.

Double diabetes means double jeopardy

10th September 2019. Dr Chee L Khoo

Have you noticed that most patients with type 1 diabetes (T1D) are not only small and petite but are often devoid of muscles when diagnosed. Insulin is a growth factor and without endogenous insulin, muscle growth is often stymied. We can’t push insulin therapy too hard because it will result in hypoglycaemia. Patients with T1D generally have normal lipids (especially triglycerides) and don’t have elements of metabolic syndrome.…

Pancreatic cancer screening – why are we not there yet?

10th September, 2019. Dr Chee L Khoo

Let’s face it. We all dread the diagnosis of pancreatic cancer in any of our patients. There aren’t too many red flags that we can rely on to warn us that something is not right with this deep seated abdominal organ. Many of the symptoms are either subtle or non-specific like nausea, intermittent epigastric pain, nausea, weight loss, loss of appetite or back pain.…

DOMTRU GP Diabetes Injectable Workshop Masterclass 2019

It’s here again. The DOMTRU GP Diabetes Injectable Workshop Masterclass will be held at Mercure Hotel, Liverpool on Sunday 10th November with a totally new agenda. Over the last 12 months we have presented numerous articles detailing the multiple trials and guidelines surrounding the usage of the new GLP1-Ras and insulins. There are now 5 different GLP1-Ras in Australia all with their different pharmacokinetics, cardiovascular outcome data and PBS listings.…