25th September 2022, Dr Chee L Khoo
We looked at the Australian guidelines on management of heart failure (HF) recently and in particular, how it impacts upon the management of these patients in primary care. The guidelines recommended the four pillars of management but also reinforced the categories of HF. Did you know that the numbers that define the different categories of HF is somewhat arbitrary?…
22nd March 2022, Dr Chee L Khoo
If you don’t already know that SGLT2 inhibitors (SGLT2i) have significant cardiovascular (and renal) benefits over and above its glucose lowering action, you better catch up with our many, many past issues at GPVoice. You should also be as familiar with the similar benefits of the GLP1 receptor agonists (GLP-1RA), especially the newer weekly injectables.…
11th Dec 2021, Dr Chee L Khoo
By now, most of you would be familiar with the significant cardiovascular benefits with all the SGLT2 inhibitors (SGLT2i). This is particularly stark in the reduction in hospitalisation for heart failure (Hhf). Of course, patients with heart failure is not a homogeneous group. There is heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection (HFrEF).…
9th September 2021, Dr Chee L Khoo
You already know that SGLT2 inhibitors, as a class, have been shown to reduce the development and progression of heart failure in patients with diabetes (1-3). Incidentally, it has also been shown to do the same in patients with heart failure but without diabetes. Life used to be simple.…
22nd May 2021, Dr Chee L Khoo
Clinical inertia in heart failure (HF) treatment means deferred initiation of additional proven beneficial therapy, which ultimately leads to preventable adverse HF events. Hospitalisation for worsening HF is a prognostically significant event in the clinical course of a patient with chronic HF (1,2). Hospitalisation for HF (hHF) identifies patients who are at high risk for subsequent disease progression, requirement for advanced therapies, and cardiovascular death.…
9th April 2021, Dr Chee L Khoo
We are all aware of the treatment inertia in the management of patients with diabetes. In patients with heart failure, several drug classes have demonstrated significant but independent survival benefit. Quadruple therapy with an angiotensin receptor–neprilsyin inhibitor (ARNI), evidence-based β-blocker, mineralo-corticoid receptor antagonist (MRA) and sodium glucose cotransporter 2 inhibitor (SGLT2i) can cumulatively reduce the risk of death by 73% over 2 years (1).…
14th September 2020, Dr Chee L Khoo
Over the last decade, there has been a push for a less glucocentric management of diabetes. For some, less glucocentric means accepting poorer glycaemic control in our patients with diabetes. It was meant to direct us to not be fixated on managing glucose control without looking at other aspects of the diabetes complications.…
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.…
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.…
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.…
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.…
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.…