Lantus® or Insulin glargine U100 is a vital tool in a significant number of our patients with type 1 and type 2 diabetes. It is the only once a day basal insulin available in Australia until recently. From the 1st July, it will no longer be available on the PBS. It’s going to be chaotic unless you are prepared for D-day.…
TI-RADS score – Ultrasound Assessment of Thyroid Nodules
I don’t know about you but I am always unsure what to do with thyroid nodules. Thyroid nodules are common, very common. So, I am frequently unsure! We either refer too many thyroid patients unnecessarily or order too many ultrasound or other thyroid scans. Finally, someone has come up with a guide to assist us GPs navigate this difficult but common condition.…
Time in Range in CGM – new metric on the block?
The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive glucose lowering in patients with type 1 diabetes (T1D) reduce the risk of long term diabetes complications (1). Similar results were demonstrated in patients with type 2 diabetes (T2D) in the UK Prospective Diabetes Study (UKPDS). But intensive glucose control involves finger pricks at least 4-8 times a day and is not sustainable in the medium to long term in most patients.…
Continuous glucose monitoring – what was just announced?
By now, you have heard that the continuous glucose monitoring “button” (Freestyle Libre) has finally been put on the NDSS. It was in the news and current affairs a few weeks ago with an interview of some politician to get their 5 minute of fame. You may even have a few patients come in asking for details. Of course, when you delve into the announcement a bit, you realise that it was a re hatching of some old news.…
Aspirin – which cancers will it benefit?
The US Preventive Services Task Force (USPSTF) recommends low-dose aspirin use for the prevention of cardiovascular disease among average-risk individuals aged 50 to 59 years with a 10% or greater 10-year risk of cardiovascular disease (1). Long-term regular aspirin use is also associated with reduced risk of obesity- and inflammation-associated cancers, particularly colorectal cancer (CRC) (2,3). Numerous follow up trials have consistently demonstrated significant reductions in risk in GI cancers – the NIH-AARP (4), the Nurses Health Study (5) and the Health Professionals Follow-up study (6,7).…
Heart Failure in diabetes – getting more complicated?
10th February 2020, Dr Chee L Khoo
Diabetes can either be the sole perpetrator of the heart failure or be an accomplice to other cardiac disease such as coronary artery disease or myocarditis. Diabetic cardiomyopathy can manifest itself either as a restrictive cardiomyopathy with heart failure with preserved ejection fraction (HFpEF) or as a dilated cardiomyopathy with heart failure wth reduced ejection fraction (HFrEF).…
Workers comp referrals – one-stop shop
Work related or motor vehicle injuries can often be tricky to manage. One not only have to look into the mechanisms of injury to assist in the diagnosis but one needs to consider the return to work schedule and restrictions. Often we need radiological investigations. That usually require approval from the insurer and that can be quite tedious. Wouldn’t it be great if someone can do the running around on our behalf.…
Diabetes risk according to family history – can we quantify the risk?
29th January 2020, Dr Chee L Khoo
If you have someone in the family with type 2 diabetes (T2D), then your risk of developing diabetes significantly increases. How much is “significant” though? Is it 2 times, 3 times or is it 10 times? Does it matter how many members in the family have diabetes? Is paternal diabetes important too? Do we know the numbers?…
New T2D hyperglycaemia management guidelines 2019 – what is new?
29th January 2020, Dr Chee L Khoo
The major difference between the 2018 American Diabetes Association/ European Association for the Study of Diabetes (ADA/EASD) consensus guidelines compared to previous guidelines were that they were less glucose centric in determining which agent to use after metformin. We used to use the most potent agent to get the sugars to target but increasingly, we are now looking at what other benefits the next agent has in addition to lowering glucose.…
Coronary artery calcification among endurance athletes – do we need to worry?
5th January 2020, Dr Chee L Khoo
Athletes and highly active people are not immune to coronary artery disease. There are some studies which suggest that despite the high levels of physical activity, these individuals have a higher prevalence of coronary artery calcification (CAC) compared with controls with low atherosclerotic risks (1,2). Is this increased level of CAC associated with increased mortality?…
Ubrogepant – the first of the gepants is out now
5th January 2020, Dr Chee L Khoo
Last week, we explore the updated pathophysiology of migraine and foreshadow the arrivals of the gepants and the “mabs” As the article went to press, the FDA approved the first of the gepants, ubrogepant for the acute (immediate) treatment of migraine with or without aura (in adults. It is not indicated for the preventive treatment of migraine.…
Pet ownership and cardiovascular mortality – is it the ownership or the walking?
4th January 2020, Dr Chee L Khoo
Anecdotal evidence suggests that having a pet reduces cardiovascular mortality. Does it? You can imagine that trying to conduct a randomised control trial can be difficult. One has to consider the pre-existing risks profile of the pet owner, physical activity pre and post pet ownership, marital status of the owner and whether pet ownership benefits men or women more.…