Quadruple therapy for heart failure – why is there treatment inertia?

9th April 2021, Dr Chee L Khoo

Quadruple therapy

We are all aware of the treatment inertia in the management of patients with diabetes. In patients with heart failure, several drug classes have demonstrated significant but independent survival benefit. Quadruple therapy with an angiotensin receptor–neprilsyin inhibitor (ARNI), evidence-based β-blocker, mineralo-corticoid receptor antagonist (MRA) and sodium glucose cotransporter 2 inhibitor (SGLT2i) can cumulatively reduce the risk of death by 73% over 2 years (1).…

White rice & T2D – both cause and effect?

29th March 2021, Dr Chee L Khoo

white rice and T2D

463 million adults  are living with diabetes globally, and this number is estimated to rise to 700 million by 2045. Interestingly, 60% of them live in Asia. By 2030, without intervention, both China and India combined will have almost half a billion of people with diabetics. While lifestyle issues and epigenetics play significant roles in the ever increasing prevalence of type 2 diabetes (T2D), white rice feature prominently in the Asian diet.…

New T2D treatment option – are you using it?

13th March 2021, Dr Chee L Khoo

diabetes treatment option

Medical treatment options for type 2 diabetes (T2D) have increased over the last decade and enhance the possibility of individualised treatment strategies where insulin is still one of them. In spite of the advancements in treatment options, less than one-third of the population with diabetes achieve their glycaemic target. What if I tell you that there is a new treatment option available that has been shown to significantly reduce HbA1c, hypoglycaemia, hospitalisation, complications and diabetic medications?…

Routine ECG in T2D – is it necessary?

!2th March 2021, Dr Chee L Khoo

Routine ECG

A substantial number of myocardial infarctions (MIs) are asymptomatic (silent MI (SMI)) or associated with minor and atypical symptoms and are found accidentally during routine electrocardiogram (ECG) examinations that reveal the existence of abnormal Q waves. The risk factors for occurrence of SMI are increasing age, hypertension, existing coronary artery disease and diabetes.…

Brain glucose control – a cause of type 2 diabetes?

17th January 2021, Dr Chee L Khoo

brain glucose control

The pathogenesis of type 2 diabetes involves insulin resistance, β-cell failure, α-cell over-activity and the loss of the incretins. The brain is responsible for homeostatic control of a broad range of variables upon which our survival depends. Why wouldn’t the brain be involved with glucose control?  There is increasing evidence that both the pancreas and the brain are jointly responsible for maintaining glucose within and tight setpoint.…

Weekly insulin is coming. Is it any good?

13th December 2020, Dr Chee Khoo

Insulin

First, we have twice daily then once daily GLP1 injections. This was followed by weekly GLP1 injectables. The same is occurring with the insulins. Once daily insulins have been around for a few years and is well established as basal insulins in patients with type 1 and type 2 diabetes. We now have a weekly insulin coming onto the market.…

Pro-opio-melanocortin deficiency obesity – what has it taught us?

obese kids?

27th November 2020, Dr Chee L Khoo

Every so often you come across reports of some “ultra-rare” disease that has a treatment available now and you probably thought that it really doesn’t concern you or your patients. In a recent small study reported in The Lancet, Karine Clément, Erica van den Akker et. al. presented the results of setmelanotide in participants with proopio-melanocortin (POMC) gene mutation which is associated with severe childhood obesity.…

Multi-use lancet device for blood glucose monitoring – URGENT cautionary tale

27th October 2020, Dr Chee L Khoo

blood glucose monitoring

Some of you would have read about the use of the multi-use lancet devices for testing different individuals that was in mandatory quarantine in Victoria between March and August this year. The lancets were disposable but the device holding the lancets were not. I thought everyone knew. I was wrong. Judging by the comments online after the publication of that issue in the Medical Republic, I suspect many of you don’t actually know the infection risk these devices pose and I felt the imperative to write this urgent article.…

Can lifestyle measures prevent GDM?

12th October 2020, Dr Chee L Khoo

We know from various diabetes prevention programs that intensive lifestyle interventions can be successful in reducing progression to diabetes. As GDM is more common in women with higher BMI and in the many high- risk groups and it is logical to ask the question “can we prevent GDM in these women?” If we could reduce progression of patients who has prediabetes to diabetes, we should, in theory, reduce prevalence of GDM in women who are at high risk of GDM.…

Hypoglycaemia in non-diabetics – is it a problem?

hypoglycaemia

27th September 2020, Dr Chee L Khoo

We know that hyperglycaemia is associated with increased cardiovascular mortality. We also know that in patients with diabetes, hypoglycaemia is also associated with increased cardiovascular morbidity and mortality. What about patients who don’t have diabetes and have low blood glucose (<4.0 mmol/L)? I am sure we all have patients who do not have diabetes but on screening blood tests, have BSL lower than 4.0 mmol/L.…

GDM Screening – Can HbA1c replace OGTT during the pandemic?

14th September 2020, Dr Chee L Khoo

We have many patients who have borderline high fasting glucose in their routine check-up. In non-pregnant adults, we have been able to use HbA1c as a generic screening test for type 2 diabetes (T2D) for some time. Unfortunately, neither non-diabetic fasting glucose readings nor HbA1c totally exclude the presence of diabetes. I am sure you have come across patients with non-diabetic fasting glucose and HbA1c but yet fail their oral glucose tolerance test (OGTT).…