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Diabetes Management – GPs as good as Diabetes Centres!

13th November 2018, Dr Chee L Khoo

70-80% of patients with type 2 diabetes (T2D) are managed in primary care in Australia. Patients managed in hospital based outpatients have the advantage of multi-disciplinary team care. They have dietitians, credentialled diabetes educator (CDE), physiotherapists and of course, the endocrinologist in the team. On the other hand, we, as GPs, have the advantage of knowing our patients and their families’ social environment.…

Dapagliflozin more than DECLARE its CV benefits

13th November 2018, Dr Chee L Khoo

It’s finally here. The Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE–TIMI 58) trial finally released their results this week at the American Heart Association (AHA) Scientific Sessions 2018. The results were most impressive but this was not just another CV outcome trial of another SGLT2 inhibitors. The results have major implications in the way we treat patients with type 2 diabetes (T2D) in general practice.…

GDM Diagnosis & Management – SWS leading the way

8th November 2018, Dr Chee L Khoo

When there is so much talk about gestational diabetes (GDM), you can’t help but think that just about every pregnant woman has GDM in south west Sydney (SWS). After all, if you look at the “high risk” group that you ought to be screening for GDM, there is hardly any woman in SWS that is not in the high risk category.…

Twincretins – are two incretins better than one?

29th October 2018, Dr Chee L Khoo

Incretins are hormones released when we eat. They augment the release of insulin from pancreatic beta cells. They not only lead to reduction in blood glucose levels via the secretion of insulin, they also inhibit glucagon release thereby stemming further hyperglycaemia, slow the absorption of nutrients by slowing gastric emptying and increase satiety. The two main incretin hormones are glucagon like peptide -1 (GLP1) and gastric inhibitory peptides (GIP).…

GLP1 agonists – are you up-to-date with them?

28th October 2018, Dr Chee L Khoo

There are now 7 glucagon like peptide 1 (GLP 1) injectable analogues used to control hyperglycaemia in patients with type 2 diabetes (T2D). An eighth GLP1 analogue is now available as an oral form. Only four of them are available in Australia of which three are on the PBS under authority prescription (Byetta, Bydureon, Trulicity).…

Finally, what comes after metformin – the latest ADA/EASD guidelines made easy

11th October 2018, Dr Chee L Khoo

Over the last 20 years, 5 classes of anti-diabetic agents are now available to choose from. This is great but which do you use after metformin? Guidelines after guidelines in Australia and internationally leave that decision up to us to make the choice on behalf of our patients. They all have different mechanisms of action but pretty much all of them have similar efficacy, reducing HbA1c by about 1.0%.…

PCOS diagnosis – an end to the dog breakfast?

11th October, 2018, Dr Chee L Khoo

The original diagnostic criteria for polycystic ovary syndrome (PCOS) put forward after the first international conference on PCOS in 1990 was oligo-anovulation and hyperandrogenism or hyperandrogenaemia in the absence of all other endocrinopathies. This was based on expert consensus rather than clinical research data. The Rotterdam criteria 2003 added ultrasound as a third diagnostic marker and to allow for a diagnosis of PCOS if two of the three criteria were met.…

Guidelines, guidelines and guidelines – the secret to keeping up to date

30th September, 2018, Dr Chee L Khoo

One of the many challenges in general practice is keeping up with new management guidelines. Another week another guideline somewhere. Even if you are made aware of the existence of those guidelines and have access to them, the guidelines are usually 150-200 pages long. Even the executive summary runs into half a dozen pages.…

Psoriatic Arthropathy & Metabolic Syndrome – the role of the GP

30th September 2018, Dr Chee L Khoo

10-40% of patients with psoriasis have joint manifestations as part of a multi-system inflammatory disease (1). There is a strong association between psoriasis and elements of metabolic syndrome. Recent evidence suggests that patients with psoriasis have increased cardio-metabolic morbidity and mortality. Like other auto-immune collagen diseases, psoriatic arthropathy (PsA) often necessitate a referral to the specialists to manage the systemic and joint disease.…

Sulfonylureas – the bad guy again!

30th September 2018, Dr Chee L Khoo

Sulfonylurea (SU) is still one of the most commonly prescribed anti-diabetic agent for type 2 diabetes (T2D)1. These patients may have put on a few kilograms of weight over the years but then they are overweight anyway. Weight gain when one gets older is pretty much expected anyway. They may have a few cardiovascular events here and there but then patients with T2D are known to have a higher risk of CV events.…

Aspirin use prevents serious CV events in diabetes but…

15th September, 2018, Dr Chee L Khoo

There is definitely a role for aspirin in preventing cardiovascular (CV) events in patients who already had a CV event (secondary prevention).  There is always a risk of gastrointestinal and intracranial bleeding.  Because the risk of another event after the first is often significantly higher, when one works out the risk benefit ratio, the benefits of aspirin use usually wins.…

Diabetic Nephropathy – time for a new strategy

15th September 2018, Dr Chee L Khoo

Glomerular Hyperfiltration

Although the physiological factors that cause early diabetic renal injury remain incompletely understood, glomerular hyperfiltration (GH) has been associated with the development of diabetic nephropathy (DN). GH leads to renin-angiotensin-aldosterone system (RAAS) activation which in turn leads to systemic vascular and endothelial abnormalities. DN not only lead to dialysis and ultimately, renal transplantation in some, it is a leading cause of mortality in patients with diabetes.…

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