SGLT2i, GLP1-RA and CVOTs – sorting out the confusion

11th August 2019, Dr Chee L Khoo

All new anti-diabetic agents since 2008 have been mandated by the US FDA to conduct cardiovascular outcome trials (CVOT) to ensure that they are safe, or in statistical jargon, “non-inferior” to placebo in relation to major adverse cardiovascular events (MACE). 15 CVOTs assessing DPP‐4 inhibitors, GLP‐1 receptor agonists and SGLT‐2 inhibitors have been completed by the end of 2018 with several others to come yet.…

At least 3 other reasons why you should use GLP1-RAs early in diabetes management

13th July 2019, Dr Chee L Khoo

New anti-diabetic agents are coming thick and fast. It is easy to get confused as to which agent to use. For injectables, there are currently at least a dozen different insulin preparations and 5 GLP1 -Receptor Analogues (GLP1-RAs) available in Australia. Some are on the Pharmaceutical Benefits Scheme (PBS), some not. It is easy to put them all in the too hard basket.…

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).…

After Metformin, which agent is better?

1st August, 2018, Dr Chee L Khoo

After metformin and sulphonylurea, under the PBS we can choose between a DPP4 inhibitor, an SGLT2 inhibitor, a thiazolidinedione or a GLP1-RA injectable. Because of the potential adverse effects of cardiac failure with thiazolidinedione, realistically, it’s a three horse race. The cost effectiveness of each of the class of agents has not been explored thus far.…

More GLP1 injectables coming onto the market – are you ready for them?

June 15, 2018, Dr Chee L Khoo 

Insulin secretion is augmented by incretins following oral glucose intake. In healthy individuals, incretins are responsible for 70% of insulin secretion. However, in patients with type 2 diabetes (T2D), the incretin effect is significantly blunted thereby affecting glucose control. Glucagon like peptide 1 (GLP1) and gastric inhibitory peptide (GIP)s are the most studied of the incretins.…