all things to do with diabetes obesity and metabolism
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.…
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.…
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.…
15th September 2018, Dr Chee L Khoo
Noxious family members?
When phagocytes engulf microorganisms, intracellular phagasome bound NADPH oxidase catalysed the production of reactive oxygen species (ROS) like superoxide and hydrogen perixoide which kills the microorganism. NADPH oxidase is also expressed on membranes of many other non-phagocytic cells. ROS play a pivotal role in many physiological processes including host defence, hormone biosynthesis, fertilisation and cellular signalling.…
15th August 2018, Dr Chee L Khoo
Diabetes can be diagnosed using a myriad of criteria – fasting glucose >7.0mmol/L, 2-hour post prandial >11.0 mmol/L or HbA1c > 6.5%. There are limitations to each of those tests and it is not one size fits all. The myriad of diagnostic tests allows clinicians to choose the most appropriate test for our patients based on their individual characteristics.…
2nd August, 2018, Dr Chee L Khoo
I first met Jack 14 years ago when he was diagnosed with T2D from an OGTT in 2005. He was a 47 years old then. He was a busy businessman with no time for exercise and eating out fairly regularly. His BMI back then was 34.7. He was already on treatment for hypertension and dyslipidaemia.…
1st August, 2018, Dr Chee L Khoo
After metformin and sulphonylurea, under the PBS we can choose between a DPP4 inhibitor, an SGLT2 inhibitor, a thiazolidinedione or a GLP1-RA injectable. Because of the potential adverse effects of cardiac failure with thiazolidinedione, realistically, it’s a three horse race. The cost effectiveness of each of the class of agents has not been explored thus far.…
1st August, 2018, Dr Chee L Khoo
We all know that unhealthy lifestyles are major risk factors for many chronic diseases and premature deaths. Many studies previously have reported that reduction in these unhealthy lifestyles can lead to increase in life expectancy of between 7.4 to 17.9 years in Japan, UK, Canada, Denmark, Norway and Germany 1-4. It would really be helpful during a consultation with our patients if we can quantify the benefit of these measures on the various chronic diseases and life expectancy.…
July 15, 2018, Dr Chee L Khoo
Diabetes can be diagnosed if fasting glucose is >7.0 mmol/L, 2 hour post prandial > 11.0 mmol/L and/or HbA1c >6.5. However, clinical guidelines recommend that we repeat testing within a “short period of time” to reduce the possibility of a false positive result. Sometimes, repeat testing may not be possible or not uncommonly, patients may be lost to follow up.…
July 1st, 2018, Dr Chee L Khoo
With early diagnosis and improved treatment, many of our cancer patients have increased survival. You may already have noticed that many of our patients being managed in the multi-disciplinary oncology units are routinely promoting healthy lifestyles. Chronic co-morbidities including diabetes and cardiovascular diseases not only affect quality of life in these survivors but are the major cause of non-cancerous mortality in cancer patients.…
June 15, 2018, Dr Chee L Khoo 
Insulin secretion is augmented by incretins following oral glucose intake. In healthy individuals, incretins are responsible for 70% of insulin secretion. However, in patients with type 2 diabetes (T2D), the incretin effect is significantly blunted thereby affecting glucose control. Glucagon like peptide 1 (GLP1) and gastric inhibitory peptide (GIP)s are the most studied of the incretins.…
June 15, 2018, Dr Chee L Khoo
In primary care, we have to battle with the increasing incidence of obesity amongst our patients. We also have to battle with the patients with depression where anti-depressants are increasingly being prescribed. Obesity is associated with depression, which is particularly common in patients with severe obesity. Antidepressant treatment may also add on to our patients’ weight.…