27th January 2019, Dr Chee L Khoo
As GPs we often see little kids already carrying extra weight and we know that many of these will go on to become overweight or obese adults. Many overweight kids and overweight adults will go on to develop type 2 diabetes. Interestingly, some obese kids don’t go on to become diabetic. Which subsets of these overweight kids don’t go on to develop diabetes?…
27th January 2019, Dr Chee L Khoo
It’s tempting to rely too much on HbA1c when managing our patients with type 2 diabetes (T2D). It is not uncommon to come across patients with pretty optimal HbA1c (under 6.5-7.0%) and we pat them on the back with the message “well done”. Often, the fasting glucose levels is just glossed over. Should we even bother with the fasting glucose levels at all these days?…
13th December 2018, Dr Chee L Khoo
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the latest therapeutic strategy in the treatment of type 2 diabetes mellitus (T2DM). They feature prominently in the latest international diabetes management guidelines. They not only improve glycaemic control but recent clinical trials demonstrated cardiovascular protection, combined with a reduction in body weight and blood pressure. There used to be three SGLT2 inhibitors, dapagliflozin, empagliflozin and canagliflozin until canagliflozin withdrew from the Australian market.…
27th November, 2018, Dr Chee L Khoo
Of the patients with type 2 diabetes (T2D) who die from cardiovascular (CV) disease, 40% die from IHD, 15% die from heart failure and 15% die from strokes. Patients with T2D have greater atherosclerotic plaque burden, higher atheroma volume, and smaller coronary artery lumen diameter than persons without diabetes. Numerous processes contribute to atherosclerotic cardiovascular disease (ASCVD) in diabetes including (but not limited to) hyperglycaemia, insulin resistance and/or hyperinsulinemia, dyslipidaemia, inflammation, reactive oxygen species, endothelial dysfunction, hypercoagulability, and vascular calcification.…
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.…
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
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).…
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.…
30th September 2018, Dr Chee L Khoo
10-40% of patients with psoriasis have joint manifestations as part of a multi-system inflammatory disease (1). There is a strong association between psoriasis and elements of metabolic syndrome. Recent evidence suggests that patients with psoriasis have increased cardio-metabolic morbidity and mortality. Like other auto-immune collagen diseases, psoriatic arthropathy (PsA) often necessitate a referral to the specialists to manage the systemic and joint disease.…
30th September 2018, Dr Chee L Khoo
Sulfonylurea (SU) is still one of the most commonly prescribed anti-diabetic agent for type 2 diabetes (T2D)1. These patients may have put on a few kilograms of weight over the years but then they are overweight anyway. Weight gain when one gets older is pretty much expected anyway. They may have a few cardiovascular events here and there but then patients with T2D are known to have a higher risk of CV events.…
15th August 2018, Dr Chee L Khoo
Diabetes can be diagnosed using a myriad of criteria – fasting glucose >7.0mmol/L, 2-hour post prandial >11.0 mmol/L or HbA1c > 6.5%. There are limitations to each of those tests and it is not one size fits all. The myriad of diagnostic tests allows clinicians to choose the most appropriate test for our patients based on their individual characteristics.…
2nd August, 2018, Dr Chee L Khoo
I first met Jack 14 years ago when he was diagnosed with T2D from an OGTT in 2005. He was a 47 years old then. He was a busy businessman with no time for exercise and eating out fairly regularly. His BMI back then was 34.7. He was already on treatment for hypertension and dyslipidaemia.…