T2D Lipid Management – are you up-to-date


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, it started to get more and more complicated.…

Fenofibrate and retinopathy – when should we use it?

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.…

NAFLD – the many treatment options in the pipeline

12th June 2022, Dr Chee L Khoo


Non-alcoholic fatty liver disease (NAFLD) is the most common liver condition in the western world. A significant proportion of these patients developed inflammation and progressed to non-alcoholic steato-hepatitis (NASH). Further and persistent inflammation can lead to cirrhosis and ultimately, to liver failure or liver cancer. Management till recently is primarily targeted towards lifestyle measures to reduce liver fat.…

Diabetic retinopathy in pregnancy – real bad news!

11th June 2022, Dr Chee L Khoo

Diabetic retinopathy

Diabetic retinopathy (DR) will affect at least 1 in 3 of our patients with diabetes. Did you know that DR is the leading cause of irreversible blindness in women of reproductive age? Further, the progression continues up to 12 months postpartum. Type 1 diabetes is on the increase and young type 2 diabetes is definitely on the rise.…

CV disease and inflammation – where do the cells come from?

22nd May 2022, Dr Chee L Khoo

The close association of inflammation and cardiovascular disease is well known for some time. Inflammation is an essential mediator of all stages of atherosclerosis, from initiation to progression and the development of thrombotic complications (1,2). Circulating immune cells play a critical role in the build-up of atherosclerotic plaques by adhering to activated endothelium and infiltrating the arterial wall to become lesional cells (3).…

PPIs and diabetes – is there a link?


13th May 2022, Dr Chee L Khoo

Another month, another commonly used class of drugs are implicated in either aggravating glucose control in patients with type 2 diabetes (T2D) or actually, increase the risk of developing T2D. This month, we a report suggesting the use of proton pump inhibitors (PPIs), as a class of agent, is associated with increased risk of developing T2D.…

Dasiglucagon – finally here?

12th May 2022, Dr Chee L Khoo

severe hypoglycaemia

It’s been more than 4 years since we herald the arrival of the stable formulation of the new glucagon, dasiglucagon in a ready-to-use delivery device for the management of hypoglycaemia. If you think about how much time is wasted in the emergency treatment of hypoglycaemia. The existing glucagon emergency kits we currently have need reconstitution before administration.…

Type 2 diabetes and cancers – what and why?

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.…

The glucose pattern that predates pancreatic cancer

21st April 2022, Dr Chee L Khoo

We have discussed the two-way relationship between pancreatic cancer and diabetes. Patients with type 2 diabetes are at 1.5-2.0 times higher risk of developing pancreatic ductal adenocarcinoma (PDAC). In patients with T2D, the development of PDAC destabilises glucose homeostasis pretty much in all patients with T2D. In patients that do not have T2D, the development of PDAC pushes them across the threshold of T2D up to 6-12 months before the diagnosis.…

GLP1-RAs and gallbladder diseases – is there a connection?

biliary system

12th April 2022, Dr Chee L Khoo

It’s almost close to a wonder drug. It is widely used in type 2 diabetes (T2D) for management of hyperglycaemia when the HbA1c is >7.0%. For that indication, it is pretty potent and in clinical trials, can reduce the HbA1c by 1-1.5%. It also assists in weight reduction and thence, reduce the core problem of insulin resistance in these patients.…

SGLT2i/GLP-1RA combo – is two better than one?

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.…