Publications by authors named "Sandra Neoh"

7 Publications

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An overview of COVID-19 in people with diabetes: Pathophysiology and considerations in the inpatient setting.

Diabet Med 2021 03 5;38(3):e14509. Epub 2021 Feb 5.

Department of Medicine Austin Health, Melbourne Medical School, The University of Melbourne, Austin Health, Heidelberg, Vic., Australia.

Introduction: The coronavirus disease (COVID-19) pandemic has continued to have a devastating impact on health worldwide. There has been a rapid evolution of evidence, establishing an increased risk of morbidity and mortality associated with diabetes and concurrent COVID-19. The objective of this review is to explore the current evidence for inpatient assessment and management of diabetes during the COVID-19 pandemic and highlight areas requiring further exploration.

Methods: A literature search of databases was conducted to November 2020 using variations on keywords SARS-CoV-2, COVID-19, SARS, MERS and diabetes. Information relating to the impact of diabetes on severity of COVID-19 infection, the impact of COVID-19 infection on diabetes management and diabetes-related complications was integrated to create a narrative review.

Discussion: People with diabetes and COVID-19 are at an increased risk of morbidity and mortality. It is important that people with both known and previously unrecognised diabetes and COVID-19 be promptly identified and assessed during acute illness, with close monitoring for clinical deterioration or complications. People with diabetes may require titration or alteration of their glycaemic management due to the potential for worse outcomes with hyperglycaemia and COVID-19 infection. Comprehensive discharge planning is vital to optimise ongoing glycaemic management.

Conclusion: Further understanding of the risk of adverse outcomes and optimisation of glycaemic management for people with diabetes during COVID-19 is required to improve outcomes. Increased glucose and ketone monitoring, substitution of insulin for some oral anti-hyperglycaemic medications and careful monitoring for complications of diabetes such as diabetic ketoacidosis should be considered.
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http://dx.doi.org/10.1111/dme.14509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883197PMC
March 2021

Considerations for people with diabetes during the Coronavirus Disease (COVID-19) pandemic.

Diabetes Res Clin Pract 2020 Aug 3;166:108296. Epub 2020 Jul 3.

Department of Medicine, Austin Health, Melbourne, Victoria, Australia; Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. Electronic address:

Introduction: The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) continues to cause havoc globally, resulting in unprecedented healthcare, societal and economic disruption. People with diabetes have been shown to be at higher risk of complications and death when exposed to pneumonia, influenza and other coronaviruses. Despite pandemic scale infection, there is currently limited understanding on the potential impact of coronavirus disease (COVID-19) on people with diabetes.

Aims: (1) To characterise the outcomes of COVID-19 for people with diabetes and (2) add value to current recommendations for healthcare providers and people with diabetes to encourage optimal management.

Methods: A search of PubMed, Embase and MEDLINE to March 2020 was undertaken, using search terms pertaining to diabetes, coronavirus and acute respiratory distress syndrome (ARDS). We briefly reviewed the epidemiology and pathophysiology of SARS-CoV-2 in the context of diabetes.

Conclusion: People with diabetes are at greater risk of severe infection and death with COVID-19. COVID-19 has significantly impacted the daily lives of individuals living with diabetes through financial implications, food and medication scarcity and its burden on mental health. In Australia, delivery of medical care has been adapted to reduce the risk of transmission, with a particular emphasis on telehealth and remote monitoring.
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http://dx.doi.org/10.1016/j.diabres.2020.108296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332442PMC
August 2020

Beware Ketoacidosis with SGLT2 Inhibitors in Latent Autoimmune Diabetes of the Adult.

Am J Med 2020 08 8;133(8):e422-e424. Epub 2020 Jan 8.

Department of Endocrinology, Northern Hospital, Epping, Victoria, Australia; Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.

Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are increasingly used for the treatment of type 2 diabetes, but have been associated with ketoacidosis.

Methods/results: We report a case series of three patients with latent autoimmune diabetes of the adult who presented with ketoacidosis, including one case with normal blood glucose levels, in the context of SGLT2 inhibitor use.

Conclusions: Sodium-glucose co-transporter-2 inhibitors should be used with caution and close clinical monitoring in patients with latent autoimmune diabetes of the adult. A clinical risk score permits targeted autoantibody testing and should be undertaken prior to commencement of SGLT2 inhibitors or cessation of insulin.
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http://dx.doi.org/10.1016/j.amjmed.2019.12.006DOI Listing
August 2020

Dietary Patterns of Insulin Pump and Multiple Daily Injection Users During Type 1 Diabetes Pregnancy.

Diabetes Care 2020 01 6;43(1):e5-e7. Epub 2019 Nov 6.

Mount Sinai Hospital, Toronto, Ontario, Canada.

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http://dx.doi.org/10.2337/dc19-1908DOI Listing
January 2020

Older People With Type 2 Diabetes-Individualizing Management With a Specialized (OPTIMISE) Community Team: Protocol for a Safety and Feasibility Mixed Methods Study.

JMIR Res Protoc 2019 Jun 7;8(6):e13986. Epub 2019 Jun 7.

Austin Health Clinical School, University of Melbourne, Heidelberg, Australia.

Background: The prevalence of diabetes is rising in older people. In 2018, over 574,000 Australians reported having diabetes. The highest prevalence (19.4%) of diabetes has been observed in people aged 85 years and older. Clinical guidelines recommend that diabetes management should be individualized; however, there is limited information regarding the current management patterns of diabetes in older people, given most clinical trials exclude participants from this age group. Available data identify that few individuals achieve optimal glycemic levels in the general population, potentially leading to adverse health outcomes and impact on quality of life. The data on glycemic profiles of older population are limited.

Objective: The aim of this study is to examine individualized diabetes management intervention for older people through home visits with a credentialed diabetes educator (CDE) and telehealth consultations with an endocrinologist located at a tertiary hospital.

Methods: This paper describes the design and methodology of a mixed methods feasibility and safety study to identify the current management of type 2 diabetes in people aged 65 years or older. We will implement and evaluate a personalized approach to management in the community of an Australian metropolitan city. This management approach will utilize flash glucose monitoring and home visits with the support of a community home nursing service CDE and telehealth consultation with an endocrinologist located at a local tertiary hospital.

Results: The study commenced in February 2017 and has recruited 43 participants, with final data collection to be completed by July 2019. Data analysis will commence after final data collection, with results expected to be published by the end of 2019.

Conclusions: This study is the first of its kind to explore individualized diabetes management for community-dwelling older people, with an aim to achieve optimal glycemic levels (glycated hemoglobin between 53 and 69 mmol/mol [7%-8.5%] depending on the fitness and frailness of the older individual). The data drawn from this study may be used to inform policy makers, service providers, clinicians, and older adults living with diabetes.

International Registered Report Identifier (irrid): DERR1-10.2196/13986.
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http://dx.doi.org/10.2196/13986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592394PMC
June 2019

Combination phentermine and topiramate for weight maintenance: the first Australian experience.

Med J Aust 2014 Aug;201(4):224-6

Department of Endocrinology, Austin Health, Melbourne, VIC, Australia.

Objective: To investigate the safety, tolerability and efficacy of combination phentermine and topiramate therapy for maintenance of weight loss.

Design, Setting And Patients: Retrospective audit of patients attending the Austin Health Weight Control Clinic who were dispensed phentermine-topiramate between 22 January 2010 and 16 July 2012 and after reaching a target weight by following a very low energy diet (VLED). Data collection continued until July 2013.

Main Outcome Measures: Number of patients who ceased pharmacotherapy; duration of use of pharmacotherapy; types and numbers of adverse effects; and mean weight and blood pressure measurements at the initial visit, the end of the VLED and the last observation during pharmacotherapy.

Results: Data were available for 103 patients who were dispensed phentermine-topiramate; 61 patients ceased combination pharmacotherapy before the end of the data collection period, 41 due to adverse effects (eg, paraesthesia, cognitive changes, dry mouth and depression). The mean duration of use of pharmacotherapy was 10 months. Mean weight decreased by 10% due to the VLED (from 135.5 kg to 122.5 kg) and this loss was maintained. For 30 patients who continued on phentermine-topiramate, the mean duration of pharmacotherapy was 22 months and the mean weight decreased by 6.7 kg between the end of the VLED and the last observation during pharmacotherapy.

Conclusion: Phentermine-topiramate therapy was not well tolerated; more than half of the patients in our study stopped taking it because of adverse effects, and more than half of the adverse events reported were ascribed to topiramate. However, in those able to continue with pharmacotherapy, the combination was efficacious for both maintenance of weight loss and ongoing weight loss.
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http://dx.doi.org/10.5694/mja13.00193DOI Listing
August 2014

A primary defect in glucose production alone cannot induce glucose intolerance without defects in insulin secretion.

J Endocrinol 2011 Sep 23;210(3):335-47. Epub 2011 Jun 23.

Department of Medicine, Heidelberg Repatriation Hospital, University of Melbourne, 300 Waterdale Road, Heidelberg Heights, Melbourne, Victoria 3081, Australia.

Increased glucose production is associated with fasting hyperglycaemia in type 2 diabetes but whether or not it causes glucose intolerance is unclear. This study sought to determine whether a primary defect in gluconeogenesis (GNG) resulting in elevated glucose production is sufficient to induce glucose intolerance in the absence of insulin resistance and impaired insulin secretion. Progression of glucose intolerance was assessed in phosphoenolpyruvate carboxykinase (PEPCK) transgenic rats, a genetic model with a primary increase in GNG. Young (4-5 weeks of age) and adult (12-14 weeks of age) PEPCK transgenic and Piebald Virol Glaxo (PVG/c) control rats were studied. GNG, insulin sensitivity, insulin secretion and glucose tolerance were assessed by intraperitoneal and intravascular substrate tolerance tests and hyperinsulinaemic/euglycaemic clamps. Despite elevated GNG and increased glucose appearance, PEPCK transgenic rats displayed normal glucose tolerance due to adequate glucose disposal and robust glucose-mediated insulin secretion. Glucose intolerance only became apparent in the PEPCK transgenic rats following the development of insulin resistance (both hepatic and peripheral) and defective glucose-mediated insulin secretion. Taken together, a single genetic defect in GNG leading to increased glucose production does not adversely affect glucose tolerance. Insulin resistance and impaired glucose-mediated insulin secretion are required to precipitate glucose intolerance in a setting of chronic glucose oversupply.
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http://dx.doi.org/10.1530/JOE-11-0126DOI Listing
September 2011