I
t’s here again. The DOMTRU GP Diabetes Injectable Workshop Masterclass will be held at Mercure Hotel, Liverpool on Sunday 10th November with a totally new agenda. Over the last 12 months we have presented numerous articles detailing the multiple trials and guidelines surrounding the usage of the new GLP1-Ras and insulins. There are now 5 different GLP1-Ras in Australia all with their different pharmacokinetics, cardiovascular outcome data and PBS listings.…
Diabetes, Obesity & Metabolism
all things to do with diabetes obesity and metabolism
Lipid guidelines – what’s new in 2019?
23rd August 2019, Dr Chee L Khoo
Remember we used to have lipid targets for patients with diabetes and patients with cardiovascular disease. Life was simple then. Just follow those numbers. Then the 2013 ACC/AHA guidelines told us to throw away those targets and put everyone with cardiovascular (CV) risk above a certain figure on maximally tolerated statins. It’s kind of set and forget strategy.…
Commercial drivers with diabetes – Do you know whose licence you can’t sign off!
12th August 2019, Dr Chee L Khoo
A truck driver with type 2 diabetes (T2D) comes in for a “driving medical”. He’s had the forms for at least 6 weeks and he hands you the blue form. “It’s due today, doc”. You are in a bit of a bind. If you don’t sign off the form today, his commercial driver’s licence will lapse tomorrow.…
SGLT2i, GLP1-RA and CVOTs – sorting out the confusion
11th August 2019, Dr Chee L Khoo
All new anti-diabetic agents since 2008 have been mandated by the US FDA to conduct cardiovascular outcome trials (CVOT) to ensure that they are safe, or in statistical jargon, “non-inferior” to placebo in relation to major adverse cardiovascular events (MACE). 15 CVOTs assessing DPP‐4 inhibitors, GLP‐1 receptor agonists and SGLT‐2 inhibitors have been completed by the end of 2018 with several others to come yet.…
Visceral fat deposits – not all fat deposits carry the same risk
28th July 2018, Dr Chee L Khoo
Visceral obesity is a better correlate with cardiometabolic risk, morbidity and mortality than general obesity. However, not all visceral fat depositions are the same. Some visceral fat depositions are worse than others in their contribution to atherosclerosis and cardiometabolic risk. The development of new imaging techniques has revolutionised the study of human body composition including measures of visceral fat.…
At least 3 other reasons why you should use GLP1-RAs early in diabetes management
13th July 2019, Dr Chee L Khoo
New anti-diabetic agents are coming thick and fast. It is easy to get confused as to which agent to use. For injectables, there are currently at least a dozen different insulin preparations and 5 GLP1 -Receptor Analogues (GLP1-RAs) available in Australia. Some are on the Pharmaceutical Benefits Scheme (PBS), some not. It is easy to put them all in the too hard basket.…
Cardiovascular health – are eggs in or out?
13th July 2019, Dr Chee L Khoo
First, it’s not good, then it’s Ok and now we are not sure. Maybe it is, maybe it isn’t. We are talking about eggs and the association with cardiovascular disease and mortality. It’s stuck in many of our and our patients’ minds that eggs are no good. It doesn’t help when the 2015-2020 Dietary Guidelines for Americans came out with somewhat contradictory recommendations: “ (1) Cholesterol is not a nutrient of concern for overconsumption” and (2) “Individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern” (1).…
Fasting or non-fasting lipid levels – does it really matter?
22nd June 2019, Dr Chee L Khoo
It is standard to measure blood lipids after an 8-12 hour fast. Pretty much all our guidelines for management of cardiometabolic conditions are based on these fasting blood levels. The actual reading is important because it guides us to determine whether a patient is commenced on a statin or not. Do meals affect lipid levels?…
Diabetic peripheral neuropathy and serum cholesterol– is lower necessarily better?
22nd June 2019, Dr Chee L Khoo
Distal polyneuropathy (DPN) is one of the more severe complications of diabetes. The exact pathologic metabolic process of DPN is still uncertain but it is more common in patients with type 2 diabetes (T2DM) than in patients with type 1 diabetes (T1DM) even after adjusting for glucose levels. Thus, in addition to hyperglycaemia, other factors could be involved in the development of DPN such as obesity, hypertension, dyslipidaemia and renal impairment. …
Checkpoint inhibitor-induced T1D – a newly emerging syndrome
8th June 2019, Dr Chee L Khoo
Checkpoint inhibitors are monoclonal antibodies that block checkpoint molecules, cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed death-1 (PD-1) and PD-1 ligand 1 (PD – L1). They have revolutionised cancer treatment because of their ability to improve survival in a growing number of cancers. Some of the cancers that have been successfully treated include melanoma, lung cancer, kidney cancer, bladder cancer, head and neck cancer, and Hodgkin’s lymphoma.…
Early weight loss following T2DM diagnosis – does the body remember?
8th June 2019, Dr Chee L Khoo
The majority of patients with type 2 diabetes (T2DM) are diagnosed and managed in primary in the early years. We know from the UKPDS that early tight glycaemic control have enduring legacy effects on cardiovascular morbidity and mortality. We also know from the DiRECT trials that significant weight loss when the diabetes duration is short can lead to diabetes remission (1,2).…
New faster acting insulin – how fast is faster?
6th June 2019, Dr Chee L Khoo
I thought short acting insulin was fast acting until fast acting insulin came along. Just when you think fast acting is truly fast acting, along came faster acting. So, what is this faster acting insulin aspart (fiasp)? Is it just another play with semantics? Or is it just another attempt in extending a patent?…