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Semaglutide: A Strategic Weapon for Primary Care 西马鲁肽:初级保健的战略武器
The Singapore family physician Pub Date : 2022-03-01 DOI: 10.33591/sfp.48.3.u3
Akshay B. Jain
{"title":"Semaglutide: A Strategic Weapon for Primary Care","authors":"Akshay B. Jain","doi":"10.33591/sfp.48.3.u3","DOIUrl":"https://doi.org/10.33591/sfp.48.3.u3","url":null,"abstract":"Type 2 diabetes has been a long-standing concern worldwide and in Singapore. Having one of the highest diabetes prevalence rates in Southeast Asia, Singapore has explored various ways of enhancing the management of chronic illnesses, one of which is to treat diabetic patients in primary care settings rather than speciality facilities. Primary care physicians are tasked to manage their diabetic patients’ glycated haemoglobin levels, along with a myriad of related complications including hypoglycaemia, cardiovascular risk, and body weight issues. With the ever-increasing complexity of population health demands, oral semaglutide can be a strategic weapon utilised by primary care doctors to treat type 2 diabetic patients. In terms of glycaemic control and body weight reduction, oral semaglutide has outperformed several other oral anti-diabetic medicines. Moreover, oral semaglutide has a proven cardiovascular safety profile with potential benefits. The development of oral semaglutide, rather than the injectable type, has made it simpler for patients to benefit from semaglutide treatment. Oral semaglutide is a feasible and effective strategy in type 2 diabetes management, for both initiation and intensification needs, and is well positioned to be a game changer in primary care.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45366554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hypoglycaemia, Cardiovascular Risk, and Weight: What are the Gold Standards for Treatment of Type 2 Diabetes? 低血糖、心血管风险和体重：治疗2型糖尿病的黄金标准是什么？
The Singapore family physician Pub Date : 2022-03-01 DOI: 10.33591/sfp.48.3.u1
M. Teh
{"title":"Hypoglycaemia, Cardiovascular Risk, and Weight: What are the Gold Standards for Treatment of Type 2 Diabetes?","authors":"M. Teh","doi":"10.33591/sfp.48.3.u1","DOIUrl":"https://doi.org/10.33591/sfp.48.3.u1","url":null,"abstract":"Hypoglycaemia is a side effect of diabetes treatment. It is commonly associated with symptoms that alert the individual to take corrective actions to prevent further reduction in blood glucose level. Impaired awareness of hypoglycaemia (IAH) refers to the diminished ability to pick up symptoms of hypoglycaemia. Patients with IAH may fail to take corrective actions to prevent worsening hypoglycaemia. Such individuals may potentially lose consciousness or fall into coma as blood glucose level continues to decrease. Hence, it is important to address hypoglycaemia during clinic consultations. Sodium-glucose-co-transporter 2 (SGLT2) inhibitors and Glucagon-like-peptide-1 (GLP-1) receptors agonists are two classes of diabetes treatment that target cardiovascular risk of type 2 diabetes treatments. These two agents should be used early in the course of treatment of diabetes. The gold standard for type 2 diabetes treatment should be aimed at lowering glycated haemoglobin, addressing cardiovascular risk, and minimising hypoglycaemia. Type 2 diabetes treatment should be patient-centred and individualised especially for elderly patients with significant comorbidities.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44202249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Capturing And Evaluting Complications in Type 2 Diabetes 2型糖尿病并发症的捕捉和评估
The Singapore family physician Pub Date : 2022-03-01 DOI: 10.33591/sfp.48.3.u4
E. Tan
{"title":"Capturing And Evaluting Complications in Type 2 Diabetes","authors":"E. Tan","doi":"10.33591/sfp.48.3.u4","DOIUrl":"https://doi.org/10.33591/sfp.48.3.u4","url":null,"abstract":"The goal of Type 2 diabetes management is to prevent and delay diabetes-related micro- and macro-vascular complications. Unfortunately, Type 2 diabetes may remain undiagnosed for years before presentation, allowing the onset of diabetes-related complications to occur even before diabetes diagnosis. Then there is the heterogeneity of Type 2 diabetes – there are thought to be subtypes within Type 2 diabetes which have different disease progression rates and risk of complications. Additionally, there is the present-day concept that the concept of Type 2 diabetes as a coronary heart risk equivalent is overly simplistic as not all patients with diabetes are at the same cardiovascular risk. Instead, individual patients will need to be risk-stratified for appropriate interventions. Despite these conundrums, protocols should be in place for early and regular complication screening, together with proactive and holistic management of diabetes mellitus. This article seeks to remind readers of what is necessary.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49264813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Semaglutide: Heart of the Matter (SUSTAIN-6 and PIONEER-6) Semaguide:物质的核心（可持续发展6号和先驱6号）
The Singapore family physician Pub Date : 2022-03-01 DOI: 10.33591/sfp.48.3.u6
R. Khurana
{"title":"Semaglutide: Heart of the Matter (SUSTAIN-6 and PIONEER-6)","authors":"R. Khurana","doi":"10.33591/sfp.48.3.u6","DOIUrl":"https://doi.org/10.33591/sfp.48.3.u6","url":null,"abstract":"T2 diabetes has long been recognised as a major and exponentially growing global public health concern. Asia is no exception. Cardiovascular adverse events remain the leading cause of morbidity and mortality in T2 diabetics. There is an urgent need for effective therapies to improve cardiovascular outcomes and glucagon-like peptide-1 receptor agonists. Semaglutide is a potent glucagon-like peptide-1 analogue with the exclusive advantage of being available in both subcutaneous and oral formulations. The cardiovascular safety of each of these formulations was assessed in the SUSTAIN-6 and PIONEER-6 trials and the observed benefits has led to the approval of both the subcutaneous and oral formulations as an adjunct to diet and lifestyle measures in high-risk patients with Type 2 diabetes.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44679308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Can He Ever Be Cared For at Home?” Discharge Care Planning for a New Bedbound Elderly 他在家里能得到照顾吗？”新一代卧床老人出院护理计划
The Singapore family physician Pub Date : 2022-03-01 DOI: 10.33591/sfp.48.3.up1
Wong Peng Yong Wong
{"title":"Can He Ever Be Cared For at Home?” Discharge Care Planning for a New Bedbound Elderly","authors":"Wong Peng Yong Wong","doi":"10.33591/sfp.48.3.up1","DOIUrl":"https://doi.org/10.33591/sfp.48.3.up1","url":null,"abstract":"This is a case of an elderly gentleman who sufferedna sudden intracranial haemorrhage, rendering himnseverely disabled and dependent with high care needs. The attending family physician in the community hospital coordinated multidisciplinary support and facilitated discharge care planning. He also managed venous thromboembolism and enteral feeding and formulated care plans for subsequent medical crises. This illustrates the importance of good generalist care in supporting such patients, their family, and caregivers in the transition from hospital to home and sustaining them in the community.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41863805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Expert Insights for PCPs in Managing CKD in T2DM PCPs在T2DM CKD管理中的专家见解
The Singapore family physician Pub Date : 2022-03-01 DOI: 10.33591/sfp.48.3.u5
Yik Tian Akira Wu
{"title":"Expert Insights for PCPs in Managing CKD in T2DM","authors":"Yik Tian Akira Wu","doi":"10.33591/sfp.48.3.u5","DOIUrl":"https://doi.org/10.33591/sfp.48.3.u5","url":null,"abstract":"Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD) in most developed countries including Singapore. Patients with DKD have a disproportionately higher risk for cardiovascular (CV) events and mortality. A comprehensive strategy is recommended for management of patients with DKD to reduce the risks of kidney disease progression and CV disease. Lifestyle modification, CV risk factor and glycaemic control, and maximum tolerated renin-angiotensin-aldosterone-system (RAAS) blockade form the foundation of DKD care. The kidney-protective effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors are well established by randomised controlled trials (RTCs) in patients with DKD, and are independent of the stage of kidney disease. Glucagon-like peptide-1 receptor agonist (GLP-1RA) is the preferred added agent to metformin and SGLT-2 inhibitor if individualised glycaemic targets are not achieved. In addition, the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone improves kidney and cardiovascular outcomes in patients with DKD.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48622634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Doctor, I Want My Stoma Reversed.” A Family Physician’s Approach to Management of New “Ostomates 医生，我要把我的口腔扭转。”家庭医生治疗新“Ostomates”的方法
The Singapore family physician Pub Date : 2022-03-01 DOI: 10.33591/sfp.48.2.up1
Xiao Han, Junjie Cai, Song En Jeffrey Jiang
{"title":"Doctor, I Want My Stoma Reversed.” A Family Physician’s Approach to Management of New “Ostomates","authors":"Xiao Han, Junjie Cai, Song En Jeffrey Jiang","doi":"10.33591/sfp.48.2.up1","DOIUrl":"https://doi.org/10.33591/sfp.48.2.up1","url":null,"abstract":"We aim to inform on the pivotal role that a family physician can play in the healthcare journey of a patient with a permanent or long-term stoma (ostomate). Mr. J, a 78-year-old retired businessman, had been newly diagnosed with moderately differentiated caecal adenocarcinoma. He was expediently sent for surgery, but subsequently developed dire post-operative complications. Mr. J underwent multiple corrective operations and managed to survive this unfortunate turn of events. However, he inadvertently found himself forced into the position of caring for his stoma, an unfamiliar entity, which became an affliction that he was initially unable to accept. Mr. J was determined to undergo stoma reversal surgery to renounce his role despite a multitude of associated risks. His family physician was able to collaborate with him to understand and elucidate his concerns and managed to pace with him to work towards living better with his stoma.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45816282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The GLP-1RAs: From Evolution to Revolution GLP-1RAs:从进化到革命
The Singapore family physician Pub Date : 2022-03-01 DOI: 10.33591/sfp.48.3.u2
N. Mishra
{"title":"The GLP-1RAs: From Evolution to Revolution","authors":"N. Mishra","doi":"10.33591/sfp.48.3.u2","DOIUrl":"https://doi.org/10.33591/sfp.48.3.u2","url":null,"abstract":"Research on incretin hormones has advanced considerably over the past few decades. Although the initial molecule – glucose-dependent insulinotropic polypeptide – failed to stimulate insulin secretion in patients with type 2 diabetes, it led to the discovery of glucagon-like peptide 1 (GLP-1). As GLP-1 impacts on various tissues and cells throughout the body, it allows patients with type 2 diabetes to benefit in many ways, in addition to lowering blood glucose levels. In a bid to harness these benefits pharmacologically, analogues were evolved from GLP-1 to produce a class of peptides known as GLP-1 receptor agonists (GLP-1RAs). The mechanism of action by which GLP-1RAs achieve their effects on lowering glucose levels, body weight, systolic blood pressure as well as lipid profiles, and improving cardiovascular and renal outcomes will be further discussed. With the advancement in research and development, the advent of scientific research and development has greatly accelerated the global implementation and local approved use of the first oral GLP-1RA, allowing the abovementioned benefits to be easily accessed. Oral GLP-1RA is set to bring about a revolution in the management of type 2 diabetes in Singapore.","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41416914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mental Capacity Assessment, LPA, Court Appointed Deputy Application, and Ethical Issues related to Mental Capacity Act – 2021 UPDATE 精神能力评估、LPA、法院指定的副申请以及与《精神能力法》相关的道德问题——2021年更新
The Singapore family physician Pub Date : 2022-03-01 DOI: 10.33591/sfp.47.2.u2
{"title":"Mental Capacity Assessment, LPA, Court Appointed Deputy Application, and Ethical Issues related to Mental Capacity Act – 2021 UPDATE","authors":"","doi":"10.33591/sfp.47.2.u2","DOIUrl":"https://doi.org/10.33591/sfp.47.2.u2","url":null,"abstract":"","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42367577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Geriatric Care 2022 老年护理2022
The Singapore family physician Pub Date : 2022-03-01 DOI: 10.33591/sfp.48.2.e
{"title":"Geriatric Care 2022","authors":"","doi":"10.33591/sfp.48.2.e","DOIUrl":"https://doi.org/10.33591/sfp.48.2.e","url":null,"abstract":"","PeriodicalId":85774,"journal":{"name":"The Singapore family physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42440465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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