“Less glucocentric diabetes management” – what does that mean to you?

14th September 2020, Dr Chee L Khoo

“Less glucocentric?”

Over the last decade, there has been a push for a less glucocentric management of diabetes. For some, less glucocentric means accepting poorer glycaemic control in our patients with diabetes. It was meant to direct us to not be fixated on managing glucose control without looking at other aspects of the diabetes complications.…

GDM screening – who, when and how?

14th September 2020, Dr Chee L Khoo

Tell me this is not, broadly, what you have in mind when you think about gestational diabetes mellitus (GDM). We know that hyperglycaemia and pregnancy does not mix well. GDM is not quite full-blown diabetes in pregnancy but is nonetheless, associated with risks for the mother and infant and with long-term metabolic consequences in both mother and child.…

Do you know this giant lurking in SWS?

27th August 2020, Dr Chee L Khoo

I first met him in December 2014 just before he started work at Western Sydney University in 2015. For someone who has just arrived in south west Sydney, I was most impressed to see how well he grasped the problems we have with the quality of care in patients with diabetes in our area.…

Medical Nutritional Therapy – why are you not prescribing it?

26th July 2020, Dr Chee L Khoo

Whenever we think about management of hyperglycaemia in patients with type 2 diabetes (T2D), we usually think about the most efficacious hypoglycaemic agent we can find (and on the PBS). If you look carefully at most management guidelines, lifestyle measures appears at the very top of the algorithm, side by side metformin. Sadly, it is often not the most prominent and usually, dismissed as an important part of the treatment algorithm.…

GLP-1 agonists – now we have 5

12th July 2020, Dr Chee L Khoo

One month ago, we discussed Ozempic®(semaglutide) as the new GLP-1 agonist kid on the block in the treatment of hyperglycaemia in patients with type 2 diabetes (T2D). We foreshadowed that it will be coming real soon. Well, sooner than I thought. Ozempic® went on the PBS on the 1st July. What we didn’t know was what the restrictions will be when prescribing for patients with T2D.…

Diabetic foot ulcers – out of sight, out of mind?

29th June 2020, Dr Chee L Khoo

diabetic foot

One in three patients with diabetes will develop diabetic foot ulcers (DFU). This typically occurs in the setting of peripheral artery disease, peripheral neuropathy and trauma. Foot ulcers invariably leads to lower extremity amputation (LEA) and both are associated with significant morbidity and mortality. We know that poor glycaemic control contributes to the development of DFU and LEA.…

T1D & T2D – different beginnings, same fate?

28th June 2020, Dr Chee L Khoo

In type 1 diabetes (T1D), the β-cell die rapidly from a massive immunological assault and practically all the β-cells are quickly lost and hence, there is an absolute deficiency of insulin secretion. Using auto-antibody screening, we can define T1D. Do you realise that we don’t actually have a definition for type 2 diabetes (T2D).…

Ozempic – another GLP-1 agonist coming real soon

12th June 2020, Dr Chee L Khoo

Whenever there are multiple brands of the same class of drugs on the market, one always wonder whether the new kid on the block is a “johnny-come-lately” trying to break into an already crowded market with yet another drug or it’s really a new kid with much better credentials. We already have 4 GLP-1 agonists in Australia and now a fifth one will be out real soon.…

Knee Osteoarthritis – is jogging good or bad?

24th May 2020, Dr Chee L Khoo

In primary care, we are frequently preventing disease or at least we try to. Apart from lifestyle measures, we prescribe statins, anti-hypertensive, aspirin and beta-blockers to reduce cardiovascular events. What about arthritis? In patients who do not have arthritis (yet) but are at high risk of degenerative osteoarthritis, is there something we can do to reduce the patients’ risk of progressing to full blown arthritis?…

Covid-19 and T2D – when two pandemics meet

13th May 2020, Dr Chee L Khoo

Covid-19 have exposed the numerous risks patients with type 2 diabetes (t2D) face when the two pandemics meet head on. We have seen that patients with diabetes are over-represented in patients hospitalised with Covid-19 in Wuhan. Patients with diabetes are also affected more severely if they contracted Covid-19 especially if glycaemic control is suboptimal.…

Diabetes and Covid-19 – the disease doesn’t take a break

11th April 2020, Dr Chee L Khoo

You are probably overwhelmed by the whole Covid-19 saga. Just because we are dealing with Covid-19 “everywhere”, doesn’t mean existing chronic diseases can take a breather. Patients with chronic illness especially diabetes and hypertension are affected by the current Covid-19 chaos in more ways then one. GPs play a vital role in managing these patients during this difficult and challenging time especially when there is much emphasis on telehealth.…