VLCD – does it work? Is it safe?

30th August 2024, A/Prof Chee L Khoo

Up until GLP1RAs +/- GIPs were shown to be efficacious in assisting patients lose weight and keeping the weight off, long term sustainable weight loss was practically unachievable. Not everyone wants to or is able to afford bariatric surgery to assist in weight loss. Even then, the weight loss is usually not sustainable. International guidelines (including Australian) include medical nutritional therapy in the management of obesity.…

Hypertriglyceridaemia – is fenofibrate all we have?

24th August 2024, A/Prof Chee L Khoo

Last fortnight we looked at the effects of hypertriglyceridaemia (HTG) on atherosclerosis. We explored the source and metabolism of triglycerides (TG). We saw how important lipoprotein lipase was in regulating plasma TG. Triglyceride levels are closely related to plasma triglycerides rich lipoprotein (TRL) and TRL remnants. All three components penetrate through the endothelium into the subendothelial space where atherosclerotic inflammation occur.…

Plasma glucose – how accurate is the reading?

24th August 2024, A/Prof Chee L Khoo

glucose analysis

Plasma glucose levels is such a simple test that we take for granted its reliability. The glucose level is absolutely critical in many of our clinical management. It governs whether we diagnose someone with diabetes or not and that have many regulatory implications. We have discussed the diagnosis and management of gestational diabetes mellitus (GDM) and how it affects maternal and offspring outcomes and future risks to both.…

Management of fatty liver disease – what works?

30th June 2024, A/Prof Chee L Khoo

MASLD

Just in case you are not aware, there will be a tsunami of patients with metabolic dysfunction associate fatty liver disease (MAFLD) or metabolic dysfunction associated steatotic liver disease (MASLD) coming to you over the next few years. Part of the reason is to do with the better recognition of the condition and we are now detecting them more with biomarkers, imaging and a high index of suspicion.…

Childhood dyslipidaemia – what happens to these kids?

30th June 2024, A/Prof Chee L Khoo

childhood dyslipidaemia

We advocate applying protective sunscreens for little babies onwards because most of the sun damage starts from young and often, we fight a losing battle trying to rescue severe sun damaged skin in later life. It wouldn’t be any different in dyslipidaemia in children and adults. When you think about it, it really doesn’t matter what age you are.…

Muscle loss with weight loss – is there a drug for it?

10th June 2024, A/Prof Chee L Khoo

muscle weakness

There will always be a certain degree of fat free mass (i.e. muscle) loss with any weight loss. While the makers of the GLP1/GIP agonists will tell you that overall, there is more fat loss than muscle loss, it is still a concern for the long term health of patients who lose muscles which may not be restored.…

The 4th Pillar in treatment of CKD

31st May 2024, A/Prof Chee L Khoo

CKD

Renin-angiotensin system (RAS) inhibitors and SGLT2 inhibitors have been the cornerstone treatment of chronic kidney disease (CKD) for many years now. They have been shown to protect kidneys and at the same time reduce adverse cardiovascular outcomes. Finerenone was recently shown to do the same. These three agents are now the guideline-directed three pillars in the treatment of CKD.…

Omega-3 supplements in pregnancy for leaner kids?

11th May 2024, A/Prof Chee L Khoo

Omega-3 supplements?

I recall reading somewhere that increasing fish intake during pregnancy results in leaner offsprings. It all makes sense as we know that ω-3 fatty acid (ω-3 FA) is beneficial for adults (also read somewhere). It must be good for babies then. Is there data on those claims? Well, sort of. We shall look into them.…

Which risk factors in T2D increase infection risk?

27th April 2024, A/Prof Chee L Khoo

glucose variability

We know that suboptimal HbA1c increases the risk of micro and macrovascular complications in people with diabetes. We also know that suboptimal HbA1c increases infection risks in these people. There is increasing evidence that glucose variability is a potent predictor of complications. There are two ways to look at glucose variability – day to day variation as seen on continuous glucose monitoring and variability in HbA1c measured over years.…

Ankle BP may predict future peripheral artery disease

27th April 2024, A/Prof Chee L Khoo

Ankle BP

PAD is associated with a high incidence of future lower-limb amputations, physical disability, cardiovascular outcomes, other serious health outcomes, reduced quality of life, and mortality (3–8). Some GPs are lucky to have tool that can easily perform ankle brachial index (ABI) as part of a cardiovascular assessment. It is a very simple tool that can detect peripheral arterial disease (PAD).…

Metformin for diabetes in pregnancy?

27th April 2024, A/Prof Chee L Khoo

Metformin has microvascular (and perhaps, macrovascular) benefits in people with type 2 diabetes (T2D). It crosses the placenta and as with all medications used in pregnancy, we always worry about its potential effects on the offspring in utero. We worry about the metabolic effects of reduced nutrients to the growing baby in there. Current recommendations (RACGP handbook) says that the pros and cons of metformin in pregnancy for women with diabetes (not GDM) are unclear (1).…

Should older T2D continue their metformin?

13th April 2024, A/Prof Chee L Khoo

Metformin

We are all used to metformin being the first line glucose lowering agent when type 2 diabetes (T2D) is diagnosed. (Well, I know some you also use metformin before diabetes is diagnosed but that’s a different story). Glucose lowering efficacy of metformin is not that terrific as we now have much stronger glucose lowering agents available.…