all things to do with diabetes obesity and metabolism
12th December 2019, Dr Chee L Khoo
Type 2 diabetes (T2D) and heart failure (HF) are common diseases with significant morbidity and mortality. Two out of three patients with T2D have evidence of ventricular dysfunction within 5 years of diabetes diagnosis (1). Data from both observational studies and clinical trial cohorts suggest that the development of HF in patients with T2DM is associated with anywhere from a 4- to 10-fold increase in mortality risk (2,3).…
12th December 2019, Dr Chee L Khoo
EMPA-REG, CANVAS, DECLARE-TIMI 58 and VERTIS-CV are cardiovascular outcome trials (CVOTs) originally designed to demonstrate non-inferiority of SGLT2 inhibitors versus placebo on major adverse cardiovascular events (MACE). These clinical trials involving a total of > 36,000 patients with type 2 diabetes (T2D) followed for 2–5 years. Patients treated with a SGLT2 inhibitor experienced a 25–35% lower risk of hospitalisation for heart failure (HHF).…
24th November 2019, Dr Chee L Khoo
It’s not often that we report on trials with negative results but this trial attracted my attention because of many issues it raised when the top-line results were announced in the Journal of American Medical Association a fortnight ago. The conclusion states “supplementation with vitamin D3 or omega-3 fatty acids, compared with placebo, resulted in no significant difference in change in eGFR at 5 years.…
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.…
13th November 2019, Drs Chee Khoo & Sobhy Khalil
We have a contribution from our GP colleague this week. Dr Sobhy Hakeem KHALIL who thoroughly studied the ADA/EASD Management of Hyperglycaemia In Type 2 Diabetes, 2018 Consensus Report and provided his take on the guidelines. I have added my comments to his take (in blue):
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).…
27th October 2019. Dr Chee L Khoo
We often hear about cardiovascular outcomes trials (COVT) involving the new anti-diabetic agents – the SGLT2 inhibitors, the DPP4 inhibitors and the GLP1-RAs. The CVOTs were meant to ensure that the agents do not have significant major adverse cardiovascular outcomes (MACE) when we prescribed them for patients with type 2 diabetes (T2D). All make sense as we need to make sure that post Phase 2 trials when these agents are used in hundreds of thousands of patients, they don’t cause more harm that good.…
11th October 2019. Dr Chee L Khoo
We all know that weight management is not as simple as a calories in calories out equation. Increasing nut consumption in particular, in theory, can cause weight gain because of nuts’ energy density but it doesn’t always translate to weight gain. In fact, a recent study showed the opposite – increased nut consumption actually is associated with reduced long term weight gain.…
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.…