all things to do with diabetes obesity and metabolism
11th October 2018, Dr Chee L Khoo
Over the last 20 years, 5 classes of anti-diabetic agents are now available to choose from. This is great but which do you use after metformin? Guidelines after guidelines in Australia and internationally leave that decision up to us to make the choice on behalf of our patients. They all have different mechanisms of action but pretty much all of them have similar efficacy, reducing HbA1c by about 1.0%.…
11th October, 2018, Dr Chee L Khoo
The original diagnostic criteria for polycystic ovary syndrome (PCOS) put forward after the first international conference on PCOS in 1990 was oligo-anovulation and hyperandrogenism or hyperandrogenaemia in the absence of all other endocrinopathies. This was based on expert consensus rather than clinical research data. The Rotterdam criteria 2003 added ultrasound as a third diagnostic marker and to allow for a diagnosis of PCOS if two of the three criteria were met.…
30th September, 2018, Dr Chee L Khoo
One of the many challenges in general practice is keeping up with new management guidelines. Another week another guideline somewhere. Even if you are made aware of the existence of those guidelines and have access to them, the guidelines are usually 150-200 pages long. Even the executive summary runs into half a dozen pages.…
30th September 2018, Dr Chee L Khoo
10-40% of patients with psoriasis have joint manifestations as part of a multi-system inflammatory disease (1). There is a strong association between psoriasis and elements of metabolic syndrome. Recent evidence suggests that patients with psoriasis have increased cardio-metabolic morbidity and mortality. Like other auto-immune collagen diseases, psoriatic arthropathy (PsA) often necessitate a referral to the specialists to manage the systemic and joint disease.…
30th September 2018, Dr Chee L Khoo
Sulfonylurea (SU) is still one of the most commonly prescribed anti-diabetic agent for type 2 diabetes (T2D)1. These patients may have put on a few kilograms of weight over the years but then they are overweight anyway. Weight gain when one gets older is pretty much expected anyway. They may have a few cardiovascular events here and there but then patients with T2D are known to have a higher risk of CV events.…
15th September, 2018, Dr Chee L Khoo
There is definitely a role for aspirin in preventing cardiovascular (CV) events in patients who already had a CV event (secondary prevention). There is always a risk of gastrointestinal and intracranial bleeding. Because the risk of another event after the first is often significantly higher, when one works out the risk benefit ratio, the benefits of aspirin use usually wins.…
15th September 2018, Dr Chee L Khoo
Glomerular Hyperfiltration
Although the physiological factors that cause early diabetic renal injury remain incompletely understood, glomerular hyperfiltration (GH) has been associated with the development of diabetic nephropathy (DN). GH leads to renin-angiotensin-aldosterone system (RAAS) activation which in turn leads to systemic vascular and endothelial abnormalities. DN not only lead to dialysis and ultimately, renal transplantation in some, it is a leading cause of mortality in patients with diabetes.…
15th September 2018, Dr Chee L Khoo
Noxious family members?
When phagocytes engulf microorganisms, intracellular phagasome bound NADPH oxidase catalysed the production of reactive oxygen species (ROS) like superoxide and hydrogen perixoide which kills the microorganism. NADPH oxidase is also expressed on membranes of many other non-phagocytic cells. ROS play a pivotal role in many physiological processes including host defence, hormone biosynthesis, fertilisation and cellular signalling.…
15th August 2018, Dr Chee L Khoo
Diabetes can be diagnosed using a myriad of criteria – fasting glucose >7.0mmol/L, 2-hour post prandial >11.0 mmol/L or HbA1c > 6.5%. There are limitations to each of those tests and it is not one size fits all. The myriad of diagnostic tests allows clinicians to choose the most appropriate test for our patients based on their individual characteristics.…
2nd August, 2018, Dr Chee L Khoo
I first met Jack 14 years ago when he was diagnosed with T2D from an OGTT in 2005. He was a 47 years old then. He was a busy businessman with no time for exercise and eating out fairly regularly. His BMI back then was 34.7. He was already on treatment for hypertension and dyslipidaemia.…
1st August, 2018, Dr Chee L Khoo
After metformin and sulphonylurea, under the PBS we can choose between a DPP4 inhibitor, an SGLT2 inhibitor, a thiazolidinedione or a GLP1-RA injectable. Because of the potential adverse effects of cardiac failure with thiazolidinedione, realistically, it’s a three horse race. The cost effectiveness of each of the class of agents has not been explored thus far.…
1st August, 2018, Dr Chee L Khoo
We all know that unhealthy lifestyles are major risk factors for many chronic diseases and premature deaths. Many studies previously have reported that reduction in these unhealthy lifestyles can lead to increase in life expectancy of between 7.4 to 17.9 years in Japan, UK, Canada, Denmark, Norway and Germany 1-4. It would really be helpful during a consultation with our patients if we can quantify the benefit of these measures on the various chronic diseases and life expectancy.…