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.…

SGLT2 inhibitors in heart failure – it’s almost an emergency!

22nd May 2021, Dr Chee L Khoo

Emergency

Clinical inertia in heart failure (HF) treatment means deferred initiation of additional proven beneficial therapy, which ultimately leads to preventable adverse HF events. Hospitalisation for worsening HF is a prognostically significant event in the clinical course of a patient with chronic HF (1,2). Hospitalisation for HF (hHF) identifies patients who are at high risk for subsequent disease progression, requirement for advanced therapies, and cardiovascular death.…

Diabetes and dementia – who is at higher risk?

Dementia

9th May 2021, Dr Chee L Kho

When we think of diabetes-related complications, we usually think about microvascular and macrovascular complications. We don’t usually think about dementia. Type 2 diabetes (T2D) represents an increasing health burden world-wide and its prevalence in particularly higher in elderly population. While epidemiological evidence suggests an increased risk of vascular and Alzheimer’s dementia associated with T2D, the mechanisms underlying the association, however, remain unclear.…

Quadruple therapy for heart failure – why is there treatment inertia?

9th April 2021, Dr Chee L Khoo

Quadruple therapy

We are all aware of the treatment inertia in the management of patients with diabetes. In patients with heart failure, several drug classes have demonstrated significant but independent survival benefit. Quadruple therapy with an angiotensin receptor–neprilsyin inhibitor (ARNI), evidence-based β-blocker, mineralo-corticoid receptor antagonist (MRA) and sodium glucose cotransporter 2 inhibitor (SGLT2i) can cumulatively reduce the risk of death by 73% over 2 years (1).…

White rice & T2D – both cause and effect?

29th March 2021, Dr Chee L Khoo

white rice and T2D

463 million adults  are living with diabetes globally, and this number is estimated to rise to 700 million by 2045. Interestingly, 60% of them live in Asia. By 2030, without intervention, both China and India combined will have almost half a billion of people with diabetics. While lifestyle issues and epigenetics play significant roles in the ever increasing prevalence of type 2 diabetes (T2D), white rice feature prominently in the Asian diet.…

New T2D treatment option – are you using it?

13th March 2021, Dr Chee L Khoo

diabetes treatment option

Medical treatment options for type 2 diabetes (T2D) have increased over the last decade and enhance the possibility of individualised treatment strategies where insulin is still one of them. In spite of the advancements in treatment options, less than one-third of the population with diabetes achieve their glycaemic target. What if I tell you that there is a new treatment option available that has been shown to significantly reduce HbA1c, hypoglycaemia, hospitalisation, complications and diabetic medications?…

Routine ECG in T2D – is it necessary?

!2th March 2021, Dr Chee L Khoo

Routine ECG

A substantial number of myocardial infarctions (MIs) are asymptomatic (silent MI (SMI)) or associated with minor and atypical symptoms and are found accidentally during routine electrocardiogram (ECG) examinations that reveal the existence of abnormal Q waves. The risk factors for occurrence of SMI are increasing age, hypertension, existing coronary artery disease and diabetes.…

Brain glucose control – a cause of type 2 diabetes?

17th January 2021, Dr Chee L Khoo

brain glucose control

The pathogenesis of type 2 diabetes involves insulin resistance, β-cell failure, α-cell over-activity and the loss of the incretins. The brain is responsible for homeostatic control of a broad range of variables upon which our survival depends. Why wouldn’t the brain be involved with glucose control?  There is increasing evidence that both the pancreas and the brain are jointly responsible for maintaining glucose within and tight setpoint.…

Weekly insulin is coming. Is it any good?

13th December 2020, Dr Chee Khoo

Insulin

First, we have twice daily then once daily GLP1 injections. This was followed by weekly GLP1 injectables. The same is occurring with the insulins. Once daily insulins have been around for a few years and is well established as basal insulins in patients with type 1 and type 2 diabetes. We now have a weekly insulin coming onto the market.…

Pro-opio-melanocortin deficiency obesity – what has it taught us?

obese kids?

27th November 2020, Dr Chee L Khoo

Every so often you come across reports of some “ultra-rare” disease that has a treatment available now and you probably thought that it really doesn’t concern you or your patients. In a recent small study reported in The Lancet, Karine Clément, Erica van den Akker et. al. presented the results of setmelanotide in participants with proopio-melanocortin (POMC) gene mutation which is associated with severe childhood obesity.…