13th April 2024, A/Prof Chee L Khoo
We are all used to metformin being the first line glucose lowering agent when type 2 diabetes (T2D) is diagnosed. (Well, I know some you also use metformin before diabetes is diagnosed but that’s a different story). Glucose lowering efficacy of metformin is not that terrific as we now have much stronger glucose lowering agents available.…
28th March 2024, A/Prof Chee L Khoo
We all know that high LDL-C is absolutely and adversely associated with cardiovascular mortality and morbidity. It’s been “proven” again and again in large clinical trials and meta-analyses after meta-analyses. Reducing lipids levels have also been shown to reduce cardiovascular (CV) events in secondary as well as in primary prevention. This is particularly the case in those with intermediate to high CV risks.…
28th March 2024, A/Prof Chee L Khoo
We all know that when type 2 diabetes (T2D) presents at a younger age, they tend to be more aggressive in its progression as well as in the complications it causes. The complications also emerge earlier as well more aggressive. There are more cardiovascular events, more renal events and now, increasingly recognised, more liver complications.…
27th January 2024, A/Prof Chee L Khoo
We are all pretty much used to weekly GLP1-RA injections for our patients with type 2 diabetes (T2D). Certainly, a lot less needles compared with the once daily or twice daily GLP1-RA injections and therefore more acceptable to patients (including those without diabetes!). Weekly GLP-1 are efficacious in reducing fasting as well as postprandial glucose.…
28th September 2023, Dr Chee L Khoo
Five years ago, we previewed the arrival of the twincretins. These are agents which contain both incretins, GLP1 and GIP. Back then, agent LY3298176 was shown to cause significant weight loss and reduction in glucose. Two years ago, agent LY3298176 finally had a name – tirzepatide. Two years ago, we looked briefly at the clinical trials comparing tirzepatide with various glucose lowering agents.…
13th August 2023, Dr Chee L Khoo
Over the last 2 decades we have seen a number of new classes of glucose-lowering agents in the management of patients with type 2 diabetes (T2D). It was quite a few years after the introduction of the thiazolidinediones (pio- and rosiglitazones) that the DPP4 inhibitors, the GLP1- RA and then SGLT2 inhibitors came along and now changed the way we manage T2D.…
11th June 2023, Dr Chee L Khoo
First, we have short acting GLP1-RA (exenatide) which requires twice a day injections. Then, we have once daily GLP1-RA injections (e.g. Exenatide ER, liraglutide, lixisenatide) which makes it more convenient for most patients. Of course, once daily injection is still too many. Once a week would be better, wouldn’t it? Of course, we now have weekly dulaglutide and semaglutide and patients love them.…
10th June 2023, Dr Chee L Khoo
It’s all very confusing, isn’t it? Low fat, low carbohydrate, Mediterranean diet, Paleo diet, Nordic diet or DASH diet. There are many other diets which we haven’t even heard of. Are they any good? Do they cause harm? How can we advise our patients if we don’t know what those diets are?…
14th May 2023, Dr Chee L Khoo
When we think about diabetic complications, we usually think about microvascular and macrovascular complications. We don’t often think about dementia as a diabetic complication. Diabetes has consistently been associated with an increased risk of dementia and its subtypes (Alzheimer’s disease and vascular dementia (1). As many with diabetes, especially T2D, are being diagnosed at a younger age, dementia relating to diabetes will increasingly be diagnosed and diagnosed at a younger age.…
26th June 2022, Dr Chee L Khoo
I was recently tasked with preparing a lecture on the current guidelines for lipid management in patients with diabetes. I thought it was quite straight forward. We have known for some years now that the targets are tighter than patients without diabetes. Thus, it can’t be that hard. As I looked into national and international guidelines, they started to get more and more complicated.…
13th June 2022, Dr Chee L Khoo
Fenofibrate is a commonly-used lipid lowering agent. In particular, it is recommended for patients with high triglycerides. Two previous studies have demonstrated that fenofibrate reduces the progression of diabetic retinopathy (DR) in patients who already have DR. Despite the benefits of fenofibrate, we don’t see recommendations for its use featured prominently in guidelines.…
24th April 2022, Dr Chee L Khoo
There have many observational studies that have shown increased risks of a variety of cancers in patients with both type 1 and type 2 diabetes independent of body mass index (BMI). Cancer is also the second most common cause of death in patients with diabetes. Up to 18% of patients with cancers have diabetes.…