all things to do with diabetes obesity and metabolism
23rd October 2022, Dr Chee L Khoo
The UKPDS 33 demonstrated that intensive glucose control had significant microvascular benefits over a 10-year period in patients with newly (< 6 years) diagnosed type 2 diabetes (1). Overall, there was a trend towards macrovascular benefits during that period but did not reach statistical significance. The participants were followed up for another 10 years after the study was published in 1997.…
13th October 2022, Dr Chee L Khoo
Obesity, type 2 diabetes mellitus (T2D), fatty liver disease, and cardiovascular disease (CVD) are complex and very inter-related cardio-metabolic conditions. Most of these conditions have lipids derangements as a major contributor to complications. While the link between lipids, in particular LDL-C, and CVD is linear and robust, there is still residual risks after aggressive treatment with lipid lowering agents.…
13th October 2022, Dr Chee L Khoo
Patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) are not only more likely to progress towards renal failure requiring dialysis or renal transplant, but also have a greater lifetime risk of cardiovascular (CV) morbidity and mortality (1). This is not surprising though, as both the kidneys and the heart share the same pathophysiology.…
25th September 2022, Dr Chee L Khoo
We looked at the Australian guidelines on management of heart failure (HF) recently and in particular, how it impacts upon the management of these patients in primary care. The guidelines recommended the four pillars of management but also reinforced the categories of HF. Did you know that the numbers that define the different categories of HF is somewhat arbitrary?…
14th September 2022, Dr Chee L Khoo
Diabetic retinopathy (DR) will affect up to 1 in 3 of our patients with diabetes. It is a sad statistic but it’s even more scary in women. In fact, DR is the leading cause of irreversible blindness in women of reproductive age. Much of the risk can be minimised or prevented in primary care.…
9th September 2022, Dr Chee L Khoo
While aspirin does provide a modest benefit in reducing nonfatal MI and nonfatal stroke events, low dose aspirin has little or no effect on cardiovascular disease mortality or all-cause mortality in patients who have not had cardiovascular disease (1). In 2016, the US Preventive Services Task Force (USPSTF) concluded that the beneficial effect of aspirin for the primary prevention of CVD was modest and occurred at doses of 100 mg or less per day (2).…
29th August 2022, Dr Chee L Khoo
By now, you would be very familiar with the additional cardiorenal benefits when you use an SGLT2 inhibitor (SGLT2i) in the management of hyperglycaemia in patients with type 2 diabetes (T2D). You would also know that the benefits are enjoyed by patients whether they have diabetes or not. DAPA-CKD published in September 2020 during the pandemic.…
28th August 2022, Dr Chee L Khoo
We know that low density lipoprotein cholesterol (LDL-C) is a risk factor for atherosclerotic cardiovascular disease (ASCVD). We also know that reducing LDL-C levels can significantly reduce those risks irrespective of whether they have established cardiovascular disease or not (1). That means reducing LDL-C works in secondary as well as primary prevention. However, even when LDL-C is well-controlled in statin-treated ASCVD patients, there is still a residual risk of cardiovascular disease.…
12th August 2022, Dr Chee L Khoo
We used to think of the islets of Langerhans as tenants in the exocrine pancreas boarding house. Like two separate cell types living under the same roof – one endocrine and the other exocrine. Both cell types happen to be involved in the business of nutrient digestion but they perform totally separate functions. Patients with diabetes are more likely to get pancreatic cancers and pancreatic exocrine insufficiency.…
8th August 2022
It’s that time of the year again. It’s Diabetes Tech & Talk 2022. it is that time of the year where we get to interact and intermingle with colleagues – GPs, endocrinologists, diabetes educators and researchers.
We are exploring Innovation and Integration in Diabetes Clinical Care, Self-management and Prevention this year. We are extremely privileged that this year’s key note speaker is Professor Dianna Magliano.…
29th July 2022, Dr Chee L Khoo
12 months ago, at GPVoice, we announced the arrival of drug LY3298176, which now has a name, tirzepatide, as the first in its class of “twincretins” in the management of type 2 diabetes. We briefly explored the 4 Phase 3 trials looking at the efficacy and safety of trizepatide in comparison with placebo, semaglutide, insulin degludec and insulin glargine.…
13th July 2022, Dr Chee L Khoo
In the last issue of GPVoice, we looked at the up-to-date guidelines in the management of dyslipidaemia in primary and secondary prevention. We looked at how complex those guidelines are. We also touched on the fact not all the evidence behind the guidelines is Level A evidence. The PCSK9 inhibitors, in particular, are a relatively new class of lipid lowering agents and the data is still coming in.…