all things to do with diabetes obesity and metabolism
12th July 2023, Dr Chee L Khoo
It’s almost a year since we foreshadowed the arrival of finerenone and it’s finally on the PBS, albeit with the usual and expected very restricted criteria. We discussed finerenone’s impressive cardiovascular and renal outcomes in patients with heart failure and chronic kidney disease. We further discussed why finerenone is a better mineralo-corticosteroid receptor antagonist (MRA) than what we have at the moment, spironolactone and eplenerone.…
25th June 2023, Dr Chee L Khoo
A few weeks ago we explored familial hypercholesterolaemia (FH) primarily in adults. The issues we touched on were how not so rare FH really is and further, how aggressive we should target the LDL-Cholesterol (LDL-C). As we know, commencing lipid lowering agents is only the first step. The next step is to agree on what the LDL-C target should be in this patient based on the cardiovascular risk of the patient.…
11th June 2023, Dr Chee L Khoo
First, we have short acting GLP1-RA (exenatide) which requires twice a day injections. Then, we have once daily GLP1-RA injections (e.g. Exenatide ER, liraglutide, lixisenatide) which makes it more convenient for most patients. Of course, once daily injection is still too many. Once a week would be better, wouldn’t it? Of course, we now have weekly dulaglutide and semaglutide and patients love them.…
10th June 2023, Dr Chee L Khoo
It’s all very confusing, isn’t it? Low fat, low carbohydrate, Mediterranean diet, Paleo diet, Nordic diet or DASH diet. There are many other diets which we haven’t even heard of. Are they any good? Do they cause harm? How can we advise our patients if we don’t know what those diets are?…
28th May 2023, Dr Chee L Khoo
Hypertriglyceridaemia has always played second fiddle to hypercholesterolaemia for a long time. Studies after studies have demonstrated the cardiovascular benefits of cholesterol lowering therapy. You might know that most of these clinical trials excluded patients with hypertriglyceridaemia. Does that mean that hypertriglyceridaemia doesn’t matter? We know hypertriglyceridaemia inflict oxidative damage to vital metabolic systems and organs.…
27th May 2023, Dr Chee L Khoo
The first GLP1- RA, exenatide was first isolated by John Eng in 1992 while working at the Veterans Administration Medical Center in the Bronx, New York.[1] It was made by Amylin Pharmaceuticals and commercialised by AstraZeneca. Exenatide was approved by the FDA on April 28, 2005, for people whose diabetes is not well controlled on other oral medications.…
14th May 2023, Dr Chee L Khoo
TOBOGM is the very first study to see if immediate treatment of early gestational diabetes mellitus (GDM) increases or reduces pregnancy complications among women with GDM diagnosed with OGTT before 20 weeks’ gestation. TOBOGM study results will significantly contribute to the management decisions of pregnant women with early GDM. Campbelltown Hospital was the lead recruiting centre with Professor David Simmons being the chief investigator of this international study.…
14th May 2023, Dr Chee L Khoo
When we think about diabetic complications, we usually think about microvascular and macrovascular complications. We don’t often think about dementia as a diabetic complication. Diabetes has consistently been associated with an increased risk of dementia and its subtypes (Alzheimer’s disease and vascular dementia (1). As many with diabetes, especially T2D, are being diagnosed at a younger age, dementia relating to diabetes will increasingly be diagnosed and diagnosed at a younger age.…
9th April 2023, Dr Chee L Khoo
One of the most important contributor to atherosclerosis is elevated cholesterol levels. Familial hypercholesterolaemia (FH) is a genetic disease that manifests as a disorder of cholesterol metabolism by mutations in hereditary genes usually in an autosomal dominant manner. Data suggest that 1 in 200 Caucasians are heterozygous for FH and that 1 in 160,000–300,000 are homozygous, which are much higher prevalence than those estimated a decade earlier (1).…
13th March 2023, NIA Diagnostic Imaging
Over the last few weeks, we have explored the many issues relating to metabolic dysfunction associated fatty liver disease (MAFLD). We looked at what else we need to do after you diagnosed MALFD. In particular, we highlighted the need to assess the degree of fibrosis in each patient with MAFLD. With the continuous advances in technology, a wide range of new techniques and imaging modalities have emerged, thus allowing for improved diagnosis of various diseases and pathologies.…
11th March 2023, Dr Chee L Khoo
Where did it come from? You would have fielded questions from more than a few patients about this new wonder cholesterol lowering drug that is coming to Australia “soon”. That’s what one of the current affairs media was hinting during the week. Of course, they make it sound as if everyone on statins is crying with muscle aches and pains.…
13th February 2023, Dr Chee L Khoo
Now that I know how common metabolic-dysfunction associated fatty liver disease (MAFLD) is especially amongst those patients with elements of metabolic syndrome, it’s hard not to assume that every second patient have MAFLD. We also know that not all MAFLD has abnormal liver function tests (LFTs). So, if you only suspect or screen only those with abnormal LFts, then you are going to miss many MAFLD.…