Diabetes – who ends up in hospital these days?

3rd January 2022, Dr Chee L Khoo

Diabetes is associated with a whole myriad of complications. Traditionally, complications were categorised into macrovascular and microvascular complications. We have added  heart failure and  arrhythmias to that list. We have made much headway and have seen declines in non-fatal incidence of these traditional diabetes complications, in parallel with declines in all-cause mortality in people diagnosed with diabetes.…

Amylin agonist – a new class of anti-obesity agents

24th December 2021, Dr Chee L Khoo

Obesity

Obesity is often the core underlying pathology leading to many degenerative and inflammatory diseases. Unfortunately, there is no easy fix to treat obesity. Over the last 12 months we have explored a number of novel molecules which have proven efficacious in reducing fat mass in patients with obesity with or without diabetes. We last looked at the up and coming tirzepatide.…

Obese yet skinny? – triple trouble

12th December 2021, Dr Chee L Khoo

old and weak or weak and old?

We touched on the subject of osteosarcopenia on a number of occasions over the years. These are people who have weak bones and have lost muscles. These are often older patients that have become weak for various reasons. Aging reduces the quality and strength of bones and muscles and increases body fat, which lead to the simultaneous occurrence of sarcopenia, osteopenia, and adiposity.…

SGLT2i and heart failure benefits – does it matter which type?

11th Dec 2021, Dr Chee L Khoo

hospitalisation for heart failure

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).…

PCSK9 inhibitors on the PBS – another kid on the block

13th November 2021, Dr Chee L Khoo

PBS Authority for PCSK9 inhibitors

The authority to prescribe a PCSK9 inhibitors for patients with resistant hyperlipidaemia under the PBS continues to be pretty complicated. We tried to simplified those numerous criteria back in December 2020 here when the criteria were “loosened” somewhat. This has facilitated my prescription of this important drug in those patients who have really, really high cardiovascular risk.…

The skinny T2D – what do we have to watch out for?

29th October 2021, Dr Chee L Khoo

Which T2D?

Traditionally, we think of diabetes as either type 1 or type 2. That’s mainly because type 1 diabetes (T1D) was discovered first and type 2 diabetes (T2D) came later. Everything that was not T1D was T2D. T1D is an auto immune disease characterised by the death of the beta cells leading to insulin deficiency while T2D is a disease of both insulin resistance and insulin deficiency.…

Dyslipidaemia in the young – who should we suspect?

24th October 2021, Dr Chee L Khoo

Last fortnight we explored the disease burden in patients who have high lipids from a very young age and the effect on their future cardiovascular risk. This consideration allows us to think about who should be aggressively treated and whom we can just safely watch, at least for a few years. It would be nice to be able identify who we should screen for high lipids from a young age so that we can start lifestyle measures early.…

Dapagliflozin Product Information – why a tiny omission means a lot?

25th September 2021, Dr Chee L Khoo

small omission

SGLT2 inhibitors (SGLT2i) have been shown to improve outcomes in patients with type 2 diabetes (T2D) and high cardiovascular risks as well as in patients with chronic kidney disease and heart failure regardless of diabetes status and independently of blood glucose levels or HbA1c. There is a little bit of a “catch” though, the eGFR.…

Reducing retinopathy progression – how does fenofibrate work?

21st August 2021, Dr Chee L Khoo

Retinopathy progression

Nothing scares patients with diabetes more than blindness. Although we have many treatment options available for proliferative diabetic retinopathy and macular oedema, diabetes remains the leading cause of severe visual impairment in working-aged adults. Diabetic retinopathy affects one in three people with diabetes. Risk factor control and screening are the cornerstones for retinopathy prevention.…

Preventing Type 1 Diabetes – are we there yet?

14th July 2021, Dr Chee L Khoo

T1D

The risk for people in the general population of developing type 1 diabetes (T1D) is about 1 in 300. For those who have a family member with T1D, the risk is 1 in 20. T1D progresses over 3 stages. In stage 1, two or more autoantibodies are already slowly attacking the β-cells. This can occur years before clinical diagnosis of T1D.…

The twincretins are here

11th July 2021, Dr Chee L Khoo

twincretin

3 years ago we previewed the highly anticipated drug LY3298176, a novel dual GLP1 and GIP receptor agonist which activate both GLP1 and GIP receptors in islet cells when we look at twincretins. In healthy human subjects, LY3298176 caused weight loss and improved glucose tolerance. In subjects with T2D, LY3298176 reduced fasting glucose, glucose excursions and body weight with increasing doses.…