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 course, the endocrinologist in the team. On the other hand, we, as GPs, have the advantage of knowing our patients and their families’ social environment.…
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 was not just another CV outcome trial of another SGLT2 inhibitors. The results have major implications in the way we treat patients with type 2 diabetes (T2D) in general practice.…
12th November 2018, Dr Chee L Khoo
Intraoperative floppy iris syndrome (IFIS) was first described by Chang and Campbell. It is characterised by floppiness of the iris, miosis and ultimately, iris prolapse through the surgical wounds. It can occur during surgery for cataract and if not anticipated, it increases the risk of posterior capsule rupture, vitreous loss, retained nuclear fragments, post op intraocular pressure spikes, irido-dialysis, hyphema and corneal endothelial loss.…
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 that you ought to be screening for GDM, there is hardly any woman in SWS that is not in the high risk category.…
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 stemming further hyperglycaemia, slow the absorption of nutrients by slowing gastric emptying and increase satiety. The two main incretin hormones are glucagon like peptide -1 (GLP1) and gastric inhibitory peptides (GIP).…
28th October 2018, Dr Chee L Khoo
Metallic objects, implants or prosthesis can render magnetic resonance imaging (MRI) unsafe or affect the quality of the images. Our patients who have metallic joint prosthesis in-situ not uncommonly require further imaging. This can pose a bit of a challenge as many of the same patient population who require the joint replacement are the same population of patient that require further imaging.…
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 are available in Australia of which three are on the PBS under authority prescription (Byetta, Bydureon, Trulicity).…
12th October 2018, Dr Chee L Khoo
Imagine a 55 year gentleman come in with right knee pain. He was an active football player from years gone by and suffered the usual meniscal tears here and there over the years. He is now a storeman in the local factory and takes his dog for a walk most days. Yes, he’s put on some weight over the years and he has usual mild hypertension, mild hypercholesterolaemia and maybe borderline glucose.…
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 us to make the choice on behalf of our patients. They all have different mechanisms of action but pretty much all of them have similar efficacy, reducing HbA1c by about 1.0%.…
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 consensus rather than clinical research data. The Rotterdam criteria 2003 added ultrasound as a third diagnostic marker and to allow for a diagnosis of PCOS if two of the three criteria were met.…
11th October 2018, Dr Chee L Khoo
Epigenetics is the modification of the DNA that changes a gene’s expression without altering the nucleotide sequence. DNA methylation and histone modifications are the most commonly studied epigenetic mechanisms by which cell structure and function can be altered during embryogenesis. The in-utero environment can lead to prenatal programming by which genes are activated or deactivated.…
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 guidelines are usually 150-200 pages long. Even the executive summary runs into half a dozen pages.…