all things to do with diabetes obesity and metabolism
22nd March 2022, Dr Chee L Khoo
If you don’t already know that SGLT2 inhibitors (SGLT2i) have significant cardiovascular (and renal) benefits over and above its glucose lowering action, you better catch up with our many, many past issues at GPVoice. You should also be as familiar with the similar benefits of the GLP1 receptor agonists (GLP-1RA), especially the newer weekly injectables.…
12th March 2022, Dr Chee L Khoo
When you look at the management of patients with type 2 diabetes (T2D), almost all the patients are on a statin for both primary and secondary prevention of cardiovascular complications. I suspect that those that are not already on a statin should be on as some doctors are not aware of the tightened lipid targets in the management of patients with T2D.…
7th March 2022, Dr Chee L Khoo
We are all familiar with various fixed dose combination of glucose lowering agents. We have DDP4 inhibitors + metformin, SGLT2 inhibitors + Metformin and SGLT2 inhibitors + DPP4 inhibitors. We also have combination insulins for some time – rapid acting insulin + long acting insulin (so-called pre-mix or co-formulations). Pharmacologically, they make sense as these combined agents either work via different mechanisms or have different pharmacokinetics.…
27th February 2022, Dr Chee L Khoo
Homozygous familial hypercholesterolaemia (HoFH) is one of those conditions that allow us to prescribe the new PCSK9 inhibitors under PBS Authority. It is a pretty rare inherited disorder resulting in extremely elevated low-density lipoprotein cholesterol (LDL) levels and significantly elevated risk of premature atherosclerotic cardiovascular disease (ASCVD). Despite the extreme high risks, HoFH is usually go unrecognised and if recognised are diagnosed late and undertreated.…
14th February 2022, Dr Chee L Khoo
TOBOGM is its final stages of recruitment. TOBOGM is the very first study to see if immediate treatment of early GDM increases or reduces pregnancy complications among women with mildly higher blood glucose diagnosed before 20 weeks’ gestation. The world is waiting on the results of this landmark study.…
27th January 2022, Dr Chee L Khoo
At GPVoice, we have covered the management of heart failure fairly comprehensively over the last couple of years. In particular, we explored the cardiovascular benefits of SGLT2 inhibitors in patients with type 2 diabetes (T2D) especially in patients with heart failure. Initial studies looked at patients with heart failure with reduced ejection fraction (HFrEF) although subsequent studies found the benefits was also seen in patients with preserve ejection fraction (HFpEF) although only empagliflozin has reported.…
3rd January 2022, Dr Chee L Khoo
Diabetes is associated with a whole myriad of complications. Traditionally, complications were categorised into macrovascular and microvascular complications. We have added heart failure and arrhythmias to that list. We have made much headway and have seen declines in non-fatal incidence of these traditional diabetes complications, in parallel with declines in all-cause mortality in people diagnosed with diabetes.…
24th December 2021, Dr Chee L Khoo
Obesity is often the core underlying pathology leading to many degenerative and inflammatory diseases. Unfortunately, there is no easy fix to treat obesity. Over the last 12 months we have explored a number of novel molecules which have proven efficacious in reducing fat mass in patients with obesity with or without diabetes. We last looked at the up and coming tirzepatide.…
12th December 2021, Dr Chee L Khoo
We touched on the subject of osteosarcopenia on a number of occasions over the years. These are people who have weak bones and have lost muscles. These are often older patients that have become weak for various reasons. Aging reduces the quality and strength of bones and muscles and increases body fat, which lead to the simultaneous occurrence of sarcopenia, osteopenia, and adiposity.…
11th Dec 2021, Dr Chee L Khoo
By now, most of you would be familiar with the significant cardiovascular benefits with all the SGLT2 inhibitors (SGLT2i). This is particularly stark in the reduction in hospitalisation for heart failure (Hhf). Of course, patients with heart failure is not a homogeneous group. There is heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection (HFrEF).…
13th November 2021, Dr Chee L Khoo
The authority to prescribe a PCSK9 inhibitors for patients with resistant hyperlipidaemia under the PBS continues to be pretty complicated. We tried to simplified those numerous criteria back in December 2020 here when the criteria were “loosened” somewhat. This has facilitated my prescription of this important drug in those patients who have really, really high cardiovascular risk.…
29th October 2021, Dr Chee L Khoo
Traditionally, we think of diabetes as either type 1 or type 2. That’s mainly because type 1 diabetes (T1D) was discovered first and type 2 diabetes (T2D) came later. Everything that was not T1D was T2D. T1D is an auto immune disease characterised by the death of the beta cells leading to insulin deficiency while T2D is a disease of both insulin resistance and insulin deficiency.…