PCSK9 inhibitors on the PBS – another kid on the block

13th November 2021, Dr Chee L Khoo

PBS Authority for PCSK9 inhibitors

The authority to prescribe a PCSK9 inhibitors for patients with resistant hyperlipidaemia under the PBS continues to be pretty complicated. We tried to simplified those numerous criteria back in December 2020 here when the criteria were “loosened” somewhat. This has facilitated my prescription of this important drug in those patients who have really, really high cardiovascular risk.…

The skinny T2D – what do we have to watch out for?

29th October 2021, Dr Chee L Khoo

Which T2D?

Traditionally, we think of diabetes as either type 1 or type 2. That’s mainly because type 1 diabetes (T1D) was discovered first and type 2 diabetes (T2D) came later. Everything that was not T1D was T2D. T1D is an auto immune disease characterised by the death of the beta cells leading to insulin deficiency while T2D is a disease of both insulin resistance and insulin deficiency.…

Dyslipidaemia in the young – who should we suspect?

24th October 2021, Dr Chee L Khoo

Last fortnight we explored the disease burden in patients who have high lipids from a very young age and the effect on their future cardiovascular risk. This consideration allows us to think about who should be aggressively treated and whom we can just safely watch, at least for a few years. It would be nice to be able identify who we should screen for high lipids from a young age so that we can start lifestyle measures early.…

Dapagliflozin Product Information – why a tiny omission means a lot?

25th September 2021, Dr Chee L Khoo

small omission

SGLT2 inhibitors (SGLT2i) have been shown to improve outcomes in patients with type 2 diabetes (T2D) and high cardiovascular risks as well as in patients with chronic kidney disease and heart failure regardless of diabetes status and independently of blood glucose levels or HbA1c. There is a little bit of a “catch” though, the eGFR.…

Reducing retinopathy progression – how does fenofibrate work?

21st August 2021, Dr Chee L Khoo

Retinopathy progression

Nothing scares patients with diabetes more than blindness. Although we have many treatment options available for proliferative diabetic retinopathy and macular oedema, diabetes remains the leading cause of severe visual impairment in working-aged adults. Diabetic retinopathy affects one in three people with diabetes. Risk factor control and screening are the cornerstones for retinopathy prevention.…

Preventing Type 1 Diabetes – are we there yet?

14th July 2021, Dr Chee L Khoo

T1D

The risk for people in the general population of developing type 1 diabetes (T1D) is about 1 in 300. For those who have a family member with T1D, the risk is 1 in 20. T1D progresses over 3 stages. In stage 1, two or more autoantibodies are already slowly attacking the β-cells. This can occur years before clinical diagnosis of T1D.…

The twincretins are here

11th July 2021, Dr Chee L Khoo

twincretin

3 years ago we previewed the highly anticipated drug LY3298176, a novel dual GLP1 and GIP receptor agonist which activate both GLP1 and GIP receptors in islet cells when we look at twincretins. In healthy human subjects, LY3298176 caused weight loss and improved glucose tolerance. In subjects with T2D, LY3298176 reduced fasting glucose, glucose excursions and body weight with increasing doses.…

SGLT2 inhibitors in heart failure – it’s almost an emergency!

22nd May 2021, Dr Chee L Khoo

Emergency

Clinical inertia in heart failure (HF) treatment means deferred initiation of additional proven beneficial therapy, which ultimately leads to preventable adverse HF events. Hospitalisation for worsening HF is a prognostically significant event in the clinical course of a patient with chronic HF (1,2). Hospitalisation for HF (hHF) identifies patients who are at high risk for subsequent disease progression, requirement for advanced therapies, and cardiovascular death.…

Diabetes and dementia – who is at higher risk?

Dementia

9th May 2021, Dr Chee L Kho

When we think of diabetes-related complications, we usually think about microvascular and macrovascular complications. We don’t usually think about dementia. Type 2 diabetes (T2D) represents an increasing health burden world-wide and its prevalence in particularly higher in elderly population. While epidemiological evidence suggests an increased risk of vascular and Alzheimer’s dementia associated with T2D, the mechanisms underlying the association, however, remain unclear.…

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).…