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Diabetes & Obesity

Diabetes Management – GPs as good as Diabetes Centres!

13th November 2018, Dr Chee L Khoo 70-80% of patients with type 2 diabetes (T2D) are managed in primary care in Australia. Patients managed in hospital based outpatients have the advantage of multi-disciplinary team care. They have dietitians, credentialled diabetes educator (CDE), physiotherapists and of…

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Dapagliflozin more than DECLARE its CV benefits

13th November 2018, Dr Chee L Khoo It’s finally here. The Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE–TIMI 58) trial finally released their results this week at the American Heart Association (AHA) Scientific Sessions 2018. The results were most impressive but this…

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GDM Diagnosis & Management – SWS leading the way

8th November 2018, Dr Chee L Khoo When there is so much talk about gestational diabetes (GDM), you can’t help but think that just about every pregnant woman has GDM in south west Sydney (SWS). After all, if you look at the “high risk” group…

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Twincretins – are two incretins better than one?

29th October 2018, Dr Chee L Khoo Incretins are hormones released when we eat. They augment the release of insulin from pancreatic beta cells. They not only lead to reduction in blood glucose levels via the secretion of insulin, they also inhibit glucagon release thereby…

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GLP1 agonists – are you up-to-date with them?

28th October 2018, Dr Chee L Khoo There are now 7 glucagon like peptide 1 (GLP 1) injectable analogues used to control hyperglycaemia in patients with type 2 diabetes (T2D). An eighth GLP1 analogue is now available as an oral form. Only four of them…

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Finally, what comes after metformin – the latest ADA/EASD guidelines made easy

11th October 2018, Dr Chee L Khoo Over the last 20 years, 5 classes of anti-diabetic agents are now available to choose from. This is great but which do you use after metformin? Guidelines after guidelines in Australia and internationally leave that decision up to…

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PCOS diagnosis – an end to the dog breakfast?

11th October, 2018, Dr Chee L Khoo The original diagnostic criteria for polycystic ovary syndrome (PCOS) put forward after the first international conference on PCOS in 1990 was oligo-anovulation and hyperandrogenism or hyperandrogenaemia in the absence of all other endocrinopathies. This was based on expert…

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Guidelines, guidelines and guidelines – the secret to keeping up to date

30th September, 2018, Dr Chee L Khoo One of the many challenges in general practice is keeping up with new management guidelines. Another week another guideline somewhere. Even if you are made aware of the existence of those guidelines and have access to them, the…

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Psoriatic Arthropathy & Metabolic Syndrome – the role of the GP

30th September 2018, Dr Chee L Khoo 10-40% of patients with psoriasis have joint manifestations as part of a multi-system inflammatory disease (1). There is a strong association between psoriasis and elements of metabolic syndrome. Recent evidence suggests that patients with psoriasis have increased cardio-metabolic…

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Sulfonylureas – the bad guy again!

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…

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Aspirin use prevents serious CV events in diabetes but…

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…

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Diabetic Nephropathy – time for a new strategy

15th September 2018, Dr Chee L Khoo 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…

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