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Oral glucose tolerance test – what should the 1 hour reading be?

15th August 2018, Dr Chee L Khoo

Diabetes can be diagnosed using a myriad of criteria – fasting glucose >7.0mmol/L, 2-hour post prandial  >11.0 mmol/L or HbA1c > 6.5%. There are limitations to each of those tests and it is not one size fits all. The myriad of diagnostic tests allows clinicians to choose the most appropriate test for our patients based on their individual characteristics.…

The many faces of hypoglycaemia

2nd August, 2018, Dr Chee L Khoo

I first met Jack 14 years ago when he was diagnosed with T2D from an OGTT in 2005. He was a 47 years old then.  He was a busy businessman with no time for exercise and eating out fairly regularly.  His BMI back then was 34.7. He was already on treatment for hypertension and dyslipidaemia.…

After Metformin, which agent is better?

1st August, 2018, Dr Chee L Khoo

After metformin and sulphonylurea, under the PBS we can choose between a DPP4 inhibitor, an SGLT2 inhibitor, a thiazolidinedione or a GLP1-RA injectable. Because of the potential adverse effects of cardiac failure with thiazolidinedione, realistically, it’s a three horse race. The cost effectiveness of each of the class of agents has not been explored thus far.…

Healthy lifestyles – how useful are they?

1st August, 2018, Dr Chee L Khoo

We all know that unhealthy lifestyles are major risk factors for many chronic diseases and premature deaths. Many studies previously have reported that reduction in these unhealthy lifestyles can lead to increase in life expectancy of between 7.4 to 17.9 years in Japan, UK, Canada, Denmark, Norway and Germany 1-4. It would really be helpful during a consultation with our patients if we can quantify the benefit of these measures on the various chronic diseases and life expectancy.…

Diagnosing Diabetes – is one reading enough?

July 15, 2018, Dr Chee L Khoo

Diabetes can be diagnosed if fasting glucose is >7.0 mmol/L, 2 hour post prandial > 11.0 mmol/L and/or HbA1c >6.5. However, clinical guidelines recommend that we repeat testing within a “short period of time” to reduce the possibility of a false positive result. Sometimes, repeat testing may not be possible or not uncommonly, patients may be lost to follow up.…

Diabetes & Cancer – it’s a two way sword.

July 1st, 2018, Dr Chee L Khoo

With early diagnosis and improved treatment, many of our cancer patients have increased survival. You may already have noticed that many of our patients being managed in the multi-disciplinary oncology units are routinely promoting healthy lifestyles. Chronic co-morbidities including diabetes and cardiovascular diseases not only affect quality of life in these survivors but are the major cause of non-cancerous mortality in cancer patients.…

More GLP1 injectables coming onto the market – are you ready for them?

June 15, 2018, Dr Chee L Khoo 

Insulin secretion is augmented by incretins following oral glucose intake. In healthy individuals, incretins are responsible for 70% of insulin secretion. However, in patients with type 2 diabetes (T2D), the incretin effect is significantly blunted thereby affecting glucose control. Glucagon like peptide 1 (GLP1) and gastric inhibitory peptide (GIP)s are the most studied of the incretins.…

Weight gain with anti-depressants – is it real?

June 15, 2018, Dr Chee L Khoo

In primary care, we have to battle with the increasing incidence of obesity amongst our patients. We also have to battle with the patients with depression where anti-depressants are increasingly being prescribed. Obesity is associated with depression, which is particularly common in patients with severe obesity. Antidepressant treatment may also add on to our patients’ weight.…

Different types of type 2 diabetes – the more the merrier?

June 1, 2018, Dr Chee L Khoo

     What? So many different types of T2D!

Have you noticed that your patients with type 2 diabetes (T2D) are a heterogeneous group? Some T2D patients are more insulin resistant than others. Some T2D patients are more insulin deficient than others. These tend to be the younger T2D. Some patients are obese and some are not.…

Hypoglycaemia is more than just an inconvenience

May 15, 2018, Dr Chee L Khoo

Unless you have experienced a severe hypoglycaemia, you don’t actually appreciate the petrifying effects it has on your patients. In addition to increased morbidity and mortality, it is associated with a reduction in health-related quality of life, increased fear and anxiety, reduced productivity and increased healthcare costs through increased utilisation of healthcare resources and blood glucose monitoring.…

Continuous Glucose Monitoring coming to general practice – are you ready?

May 15, 2018, Dr Chee L  Khoo

You probably think that insulin pump (so-called continuous subcutaneous insulin infusion or CSII) and continuous glucose monitoring (CGM) are all to do with Type 1 diabetes (T1D) in diabetes centres and you probably don’t need to know about it, you are probably right. Well, almost. I mean, how often do you come across CGM and CSII in general practice?…

SGLT2 inhibitor/DPP4 inhibitor combo under PBS – sorting out the confusion

May 1, 2018 Dr Chee L Khoo

When I wrote the article last fortnight about new SLT2 inhibitor/DPP4 inhibitor combo now on the PBS, the situation was still very confused. Since that article, more information has  come to light. Yes, we are allowed to use both DPP4 inhibitors (DPP4i) and SLGT2 inhibitors (SGLT2i) together when patients with type 2 diabetes (T2D) if the HbA1c is >7.0%.…

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