29th January 2020, Dr Chee L Khoo
If you have someone in the family with type 2 diabetes (T2D), then your risk of developing diabetes significantly increases. How much is “significant” though? Is it 2 times, 3 times or is it 10 times? Does it matter how many members in the family have diabetes? Is paternal diabetes important too? Do we know the numbers?…
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.…
14th November 2019, Dr Chee L Khoo
Oral therapy for T2D – navigating the PBS maze
During our recent GP Diabetes Injectable Masterclass Workshop, I noted that there was a lot of uncertainty and confusion in relation to what oral agents can be combined under the PBS. This uncertainty and confusion can only lead to hesitation to escalate treatment in patients whose glycaemic control is suboptimal.…
27th October 2019. Dr Chee L Khoo
In medicine, newer is usually better although sometimes, we can be sceptical whether “newer” means a sneaky way to extend patents. The newer, second generation insulins, Toujeo® (insulin glargine U300 or GLA-300) and Degludec® are truly better insulins. Diabetes Therapy recently published a practical guide to the use of these second generation insulins (1).…
7th October 2019. Dr Chee L Khoo
GPs are the experts in the practice of the art of medicine. There is a lot of subtle negotiation, bargaining and a touch of scare tactics that goes on when we consult with a patient with a chronic and complex disease. Patients with type 2 diabetes (T2D) comes as complex as you can get.…
6th October 2019. Dr Chee L Khoo
Last month we looked at the state of play with screening for the deadly disease, pancreatic ductal adenocarcinoma (PDAC). We saw how it may not be useful to screen the general population with the technology that we have but there are select higher risk groups where screening may be useful. Long standing type 2 diabetes (T2DM) is a modest risk factor for PDAC.…
28th September 2019. Dr Chee L Khoo
I have known Greg for about 30 years. He is now 63 years old and has amongst many medical conditions, type 2 diabetes (T2D). He is a working class telephony technician. I have seen him and his children grown up. They are now adult kids but Greg, like the usual middle aged Australian, has gradually grown fatter and less healthy over the years.…
14th September 2019. Dr Chee L Khoo
We all have patients similar to this presenting to the practice not that infrequently. This is a real case that I came across just recently. Joanne was referred to the practice by a friend of a friend. She had just been discharged from the local hospital after three weeks following amputation of the lateral two toes of her right foot.…
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.…
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.…
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).…
14th March 2018, Dr Chee L Khoo
Bariatric/metabolic surgery is an effective strategy to attain diabetes remission in obese patients. Significant and rapid weight loss by any means will improve insulin sensitivity, the internal glucotoxicity and lipotoxicity. Bariatric surgery, in particular, is thought to also lead to changes in gut incretins and neurotransmitters, improvement of hepatic and peripheral insulin sensitivity, altered bile acid metabolism and gut microbiota that are independent of weight loss.…