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How to create a weight loss program for patients with T2D

13th May 2019, Dr Chee L Khoo

Type 2 diabetes is strongly associated with obesity and abnormal fat distribution. Fat loss especially from the liver and pancreas have been shown to reduce insulin resistance and, in some cases, lead to diabetes remission. Bariatric surgery can achieve significant weight loss and a significant proportion of patients achieved diabetes remission with weight loss (reference needed).…

The young T2D – more trouble ahead than you think

13th May 2019, Dr Chee L Khoo

You are already seeing the worrying trend of younger and younger patients being diagnosed with type 2 diabetes (T2D). My youngest is 25 years old when first diagnosed with T2D. I am sure many of you have patients younger than that. Of course, we need to make sure that these are not patients with type 1 diabetes.…

Ramadan is here – do we need to do anything different with patients with diabetes?

13th May 2019, Dr Chee L Khoo

Ramadan is the holy month for Muslims, falling in the ninth lunar month in the Islamic calendar year. Because the timing of Ramadan is linked to the sighting of the new moon, the timing of this month varies. Ramadan is a period of worship, self-discipline, austerity and charity. The most important significance of Ramadan is that Muslims are required to observe fasting during daylight hours.…

Diabetes inducing drugs – who is next on the list?

13th May 2019, Dr Chee L Khoo

The list of drugs that increase the risk of type 2 diabetes (T2D) is increasing. We know statins (1,2), anti-psychotics (3) and many of the anti-retroviral (4) and immunosuppressant agents (5) have been shown to increase the risk of T2D. We also heard last year about the ACE inhibitors. Recent studies have implicated the 5α-reductase inhibitors, the drugs that we use to treat benign prostatic hypertrophy (BPH) as well.…

Breakfast – how important is it?

23rd April, 2019, Dr Chee L Khoo

Somehow, it has been drummed into us, as doctors and consumers, that breakfast is the most important meal of the day. What does that even mean? As discerning scientists, we should seek to clarify what outcome measures they are referring to when they say, “the most important meal of the day”. We should also question what type of breakfast they are referring to and the subjects recruited in the studies.…

Weight loss with Duromine® – how safe is Duromine®?

14th April 2019, Dr Chee L Khoo

It’s difficult, isn’t it? Patients who are overweight or obese often has either significant cardiovascular risks or already have cardiovascular co-morbidities. These are the patients that need some assistance with weight loss but we always hesitate to prescribe Duromine®. We were taught and warned about the “dangers” of the drug especially in relation to “cardiovascular disease” and blood pressure.…

Reduction of major CV events by SGLT2 inhibitors – who will benefit from what?

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.…

Low birth weight and future cardiovascular risk – how are they connected?

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.…

Continuous glucose monitoring – how accurate are they?

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.…

Fournier’s gangrene & SGLT2i – how rare is it?

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.…

Maintaining weight loss in primary care – is it possible?

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.…

Insulin-GLP1 agonist combo – two heads better than one

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).…

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