SGLT2 inhibitors and the diabetic kidney – friend or foe?

26th May 2019, Dr Chee L Khoo

Sometimes when a drug is contraindicated for patients with low eGFR, it may mean that usage of the drug may further damage the kidneys or increase the risk of certain adverse events. For example, the use of metformin in patients with eGFR <30 significantly increase the risk of lactic acidosis. Usage of lithium in patients with impaired renal function (low eGFR) may further damage the kidneys.…

GP: The centre of type 2 diabetes care – are you up to the task?

26th May 2019, Dr Chee L Khoo

GPs in south west Dydney (SWS) are increasingly overwhelmed by the numbers of patients with type 2 diabetes (T2DM) coming through the doors. We know that this cohort have a more “aggressive” disease and much higher and earlier complication rates. T2DM continues to be strongly associated with numerous cardiovascular and renal complications.…

Breakfast – how important is it?

23rd April, 2019, Dr Chee L Khoo

Somehow, it has been drummed into us, as doctors and consumers, that breakfast is the most important meal of the day. What does that even mean? As discerning scientists, we should seek to clarify what outcome measures they are referring to when they say, “the most important meal of the day”. We should also question what type of breakfast they are referring to and the subjects recruited in the studies.…

“Ideal” BP in the Elderly – what is the target again?

22nd April 2019, Dr Chee L Khoo

Hardening of the arteries” is pretty much inevitable when one gets older. A majority of our patients >70 years old are on anti-hypertensive treatment. The problem is they keep changing the targets we are meant to be aiming for in this cohort of patients. The ACC/AHA High Blood Pressure guidelines 2017 recommends 130/80 mmHg even for patients >70 years old (1).…

Groin pain in adolescents – is that slipped capital femoral epiphysis?

22nd April 2019, Dr Chee L Khoo

One of the diagnoses I dread to miss in general practice is slipped capital femoral epiphysis (SCFE). It is not common (yet) but most general practitioners will encounter (or miss) a few of these in their life time. They are mostly seen during the adolescent years and are more prevalent although not exclusively, in the overweight and obese.…

Weight loss with Duromine® – how safe is Duromine®?

14th April 2019, Dr Chee L Khoo

It’s difficult, isn’t it? Patients who are overweight or obese often has either significant cardiovascular risks or already have cardiovascular co-morbidities. These are the patients that need some assistance with weight loss but we always hesitate to prescribe Duromine®. We were taught and warned about the “dangers” of the drug especially in relation to “cardiovascular disease” and blood pressure.…

Reduction of major CV events by SGLT2 inhibitors – who will benefit from what?

13th April 2019, Dr Chee L Khoo

SGLT2 inhibitors, as a class of anti-diabetic drugs, have been shown in multiple cardiovascular outcomes trials (EMPA-REQ, DECLARE-TIMI 58, CANVAS) to “reduce cardiovascular events in patients with type 2 diabetes (T2D)”. These are big headlines but as obsessive clinicians, we need to be more specific in the benefits of SGLT2 inhibitors in patients with T2D.…

Low birth weight and future cardiovascular risk – how are they connected?

13th April 2019, Dr Chee L Khoo

We know that overweight children have higher future risk of cardiovascular disease and diabetes.  Ironically, babies who are small at birth or during infancy also have increased rates of cardiovascular disease and diabetes as adults. It is thought that foetal undernutrition at different stages of gestation are somehow link to this increased risk, but the underlying mechanism is not fully understood.…

Cerebral Amyloid Angiopathy – a real case study

We read last fortnight about cerebral amyloid angiopathy (CAA). I am not sure that I can pick up a CAA when I see one. I mean, we are not experts in CT or MRI of the brain. A fairly obvious, bit chunk of an  infarct is easy to spot. I can also pick up any asymmetry in the scan. Any more than that, i will have reached out to the printed report.…

Fournier’s gangrene & SGLT2i – how rare is it?

23rd March 2019, Dr Chee L Khoo

You may remember receiving warnings recently from the Therapeutics Goods Administration (TGA) about a serious “rare” infection, called necrotising fasciitis of the perineum, also referred to as Fournier’s gangrene (FG). FG is reported to be associated with the use of SGLT2 inhibitors in patients with type 2 diabetes (T2D). The warning came on the back of similar warnings by the US Food and Drug Authority (FDA) in August 2018.…

Maintaining weight loss in primary care – is it possible?

23rd March 2018, Dr Chee L Khoo

The DiRECT trial is really a landmark study which shows that remission of type 2 diabetes (T2D) is possible with weight loss and more importantly, it can be achieved in primary care. The result from DiRECT was most impressive when published 12 months ago but the 2 burning questions on everyone’s mind were (1) Is the weight loss sustainable and (2) Is the diabetes remission maintained?” at the end of 24 months.…

Insulin-GLP1 agonist combo – two heads better than one

23rd March 2019, Dr Chee L Khoo

American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) suggest that if HbA1c targets are not achieved despite the addition of basal insulin in type 2 diabetes (T2D), treatment could also be further advanced by the addition of a glucagon-like peptide-1 receptor agonist (GLP-1 RA). The addition of a GLP1-RA has been shown to be as efficacious as the addition of a prandial insulin in patients with T2D who is not at glycaemic target despite the addition of basal insulin therapy (1).…