Omega-3 supplements in pregnancy for leaner kids?

11th May 2024, A/Prof Chee L Khoo

Omega-3 supplements?

I recall reading somewhere that increasing fish intake during pregnancy results in leaner offsprings. It all makes sense as we know that ω-3 fatty acid (ω-3 FA) is beneficial for adults (also read somewhere). It must be good for babies then. Is there data on those claims? Well, sort of. We shall look into them.…

Which risk factors in T2D increase infection risk?

27th April 2024, A/Prof Chee L Khoo

glucose variability

We know that suboptimal HbA1c increases the risk of micro and macrovascular complications in people with diabetes. We also know that suboptimal HbA1c increases infection risks in these people. There is increasing evidence that glucose variability is a potent predictor of complications. There are two ways to look at glucose variability – day to day variation as seen on continuous glucose monitoring and variability in HbA1c measured over years.…

Ankle BP may predict future peripheral artery disease

27th April 2024, A/Prof Chee L Khoo

Ankle BP

PAD is associated with a high incidence of future lower-limb amputations, physical disability, cardiovascular outcomes, other serious health outcomes, reduced quality of life, and mortality (3–8). Some GPs are lucky to have tool that can easily perform ankle brachial index (ABI) as part of a cardiovascular assessment. It is a very simple tool that can detect peripheral arterial disease (PAD).…

Metformin for diabetes in pregnancy?

27th April 2024, A/Prof Chee L Khoo

Metformin has microvascular (and perhaps, macrovascular) benefits in people with type 2 diabetes (T2D). It crosses the placenta and as with all medications used in pregnancy, we always worry about its potential effects on the offspring in utero. We worry about the metabolic effects of reduced nutrients to the growing baby in there. Current recommendations (RACGP handbook) says that the pros and cons of metformin in pregnancy for women with diabetes (not GDM) are unclear (1).…

Should older T2D continue their metformin?

13th April 2024, A/Prof Chee L Khoo


We are all used to metformin being the first line glucose lowering agent when type 2 diabetes (T2D) is diagnosed. (Well, I know some you also use metformin before diabetes is diagnosed but that’s a different story). Glucose lowering efficacy of metformin is not that terrific as we now have much stronger glucose lowering agents available.…

Intermittent fasting – can it be harmful?

31st March 2024, A/Prof Chee L Khoo

Time restricted eating

In case you have not noticed, there was some disquiet in the cardiovascular community this week on the potential harm intermittent fasting can cause. The headline presentation says “8-hour time-restricted eating linked to a 91% higher risk of cardiovascular death”. Well, any study regarding “diets” are always going to be sus.…

Lipid lowering in T2D – what happens if you don’t treat to guidelines?

28th March 2024, A/Prof Chee L Khoo

We all know that high LDL-C is absolutely and adversely associated with cardiovascular mortality and morbidity. It’s been “proven” again and again in large clinical trials and meta-analyses after meta-analyses. Reducing lipids levels have also been shown to reduce cardiovascular (CV) events in secondary as well as in primary prevention. This is particularly the case in those with intermediate to high CV risks.…

Young T2D – do they get more cancers?

28th March 2024, A/Prof Chee L Khoo

Young T2D

We all know that when type 2 diabetes (T2D) presents at a younger age, they tend to be more aggressive in its progression as well as in the complications it causes. The complications also emerge earlier as well more aggressive. There are more cardiovascular events, more renal events and now, increasingly recognised, more liver complications.…

Lean body mass loss – can we prevent it?

7th March 2024, A/Prof Chee L Khoo

Total body weight loss

There was some kerfuffle recently in the lay press about muscle loss with semaglutide. Great horror? Well, it doesn’t matter how you lose the weight. Any significant body weight loss will incur lean body mass loss (LBM). It’s not unique to GLP1-RA injections. Weight loss from bariatric surgery, dietary restrictions or just healthier eating will do the same.…

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.…