all things to do with diabetes obesity and metabolism
8th June 2019, Dr Chee L Khoo
The majority of patients with type 2 diabetes (T2DM) are diagnosed and managed in primary in the early years. We know from the UKPDS that early tight glycaemic control have enduring legacy effects on cardiovascular morbidity and mortality. We also know from the DiRECT trials that significant weight loss when the diabetes duration is short can lead to diabetes remission (1,2).…
6th June 2019, Dr Chee L Khoo
I thought short acting insulin was fast acting until fast acting insulin came along. Just when you think fast acting is truly fast acting, along came faster acting. So, what is this faster acting insulin aspart (fiasp)? Is it just another play with semantics? Or is it just another attempt in extending a patent?…
26th May 2019, Dr Chee L Khoo
Sometimes when a drug is contraindicated for patients with low eGFR, it may mean that usage of the drug may further damage the kidneys or increase the risk of certain adverse events. For example, the use of metformin in patients with eGFR <30 significantly increase the risk of lactic acidosis. Usage of lithium in patients with impaired renal function (low eGFR) may further damage the kidneys.…
26th May 2019, Dr Chee L Khoo
GPs in south west Dydney (SWS) are increasingly overwhelmed by the numbers of patients with type 2 diabetes (T2DM) coming through the doors. We know that this cohort have a more “aggressive” disease and much higher and earlier complication rates. T2DM continues to be strongly associated with numerous cardiovascular and renal complications.…
23rd May, 2019. Dr Chee L Khoo
How to implement a low calorie diet for weight loss in general practice
In the last issue, we described our retrospective audit of all the patients at my practice who has a diagnosis of type 2 diabetes and who was offered a low calorie, low carbohydrate diet program between January and May 2018. In general, all patients with type 2 diabetes were offered a partial meal replacement (two sachets plus a meal) and regular follow up over the subsequent 12 months.…
13th May 2019, Dr Chee L Khoo
Type 2 diabetes is strongly associated with obesity and abnormal fat distribution. Fat loss especially from the liver and pancreas have been shown to reduce insulin resistance and, in some cases, lead to diabetes remission. Bariatric surgery can achieve significant weight loss and a significant proportion of patients achieved diabetes remission with weight loss (reference needed).…
13th May 2019, Dr Chee L Khoo
You are already seeing the worrying trend of younger and younger patients being diagnosed with type 2 diabetes (T2D). My youngest is 25 years old when first diagnosed with T2D. I am sure many of you have patients younger than that. Of course, we need to make sure that these are not patients with type 1 diabetes.…
13th May 2019, Dr Chee L Khoo
Ramadan is the holy month for Muslims, falling in the ninth lunar month in the Islamic calendar year. Because the timing of Ramadan is linked to the sighting of the new moon, the timing of this month varies. Ramadan is a period of worship, self-discipline, austerity and charity. The most important significance of Ramadan is that Muslims are required to observe fasting during daylight hours.…
13th May 2019, Dr Chee L Khoo
The list of drugs that increase the risk of type 2 diabetes (T2D) is increasing. We know statins (1,2), anti-psychotics (3) and many of the anti-retroviral (4) and immunosuppressant agents (5) have been shown to increase the risk of T2D. We also heard last year about the ACE inhibitors. Recent studies have implicated the 5α-reductase inhibitors, the drugs that we use to treat benign prostatic hypertrophy (BPH) as well.…
23rd April, 2019, Dr Chee L Khoo
Somehow, it has been drummed into us, as doctors and consumers, that breakfast is the most important meal of the day. What does that even mean? As discerning scientists, we should seek to clarify what outcome measures they are referring to when they say, “the most important meal of the day”. We should also question what type of breakfast they are referring to and the subjects recruited in the studies.…
14th April 2019, Dr Chee L Khoo
It’s difficult, isn’t it? Patients who are overweight or obese often has either significant cardiovascular risks or already have cardiovascular co-morbidities. These are the patients that need some assistance with weight loss but we always hesitate to prescribe Duromine®. We were taught and warned about the “dangers” of the drug especially in relation to “cardiovascular disease” and blood pressure.…
13th April 2019, Dr Chee L Khoo
SGLT2 inhibitors, as a class of anti-diabetic drugs, have been shown in multiple cardiovascular outcomes trials (EMPA-REQ, DECLARE-TIMI 58, CANVAS) to “reduce cardiovascular events in patients with type 2 diabetes (T2D)”. These are big headlines but as obsessive clinicians, we need to be more specific in the benefits of SGLT2 inhibitors in patients with T2D.…