Journal of the ASEAN Federation of Endocrine Societies最新文献

{"title":"Challenges in Glycemic Monitoring: Undetectable HbA1c Level in an Asymptomatic Patient With Hemoglobin E and Beta-Thalassemia Minor: A Case Report.","authors":"Dita Prawitasari, Syaifuddin Zuhri, Robiul Fuadi","doi":"10.15605/jafes.041.02.6223","DOIUrl":"10.15605/jafes.041.02.6223","url":null,"abstract":"<p><p>Glycated hemoglobin (HbA1c) is a laboratory examination recommended by the American Diabetes Association to monitor blood glucose levels in patients with diabetes mellitus. This gold standard method for testing HbA1c uses highperformance liquid chromatography (HPLC). One advantage of HbA1c testing with HPLC is the ability to detect Hb variants or hemoglobinopathies, although HbA1c results may become irrelevant in such conditions. A 49-year-old female patient came to the Ophthalmology Outpatient Clinic of Dr. Soetomo Hospital due to visual impairment in both eyes and plans for cryotherapy surgery. In preparation for the surgery, laboratory tests were performed with results of haemoglobin 12.1 g/dL, mean corpuscular volume 58.9 fL, mean corpuscular haemoglobin 19.3 pg, leukocytes 13,370/uL, platelets 399,000/uL and random blood glucose 127 mg/dL; however, HbA1c was not detected. In the HbA1c test, a 93.7% window variant was obtained. Based on blood smear evaluation, there was hypochromic microcytic anisopoikilocytosis with target cells. The electrophoresis results revealed HbA 0.7%, HbF 0.6%, HbE 94.9% and HbA2 4.7%, indicating the presence of beta thalassemia with hemoglobinopathy E. The diagnosis of hemoglobinopathy E is based on a complete blood count, peripheral blood smear and haemoglobin electrophoresis. HbA1c examination by HPLC can yield undetectable HbA1c levels in hemoglobinopathies. Monitoring blood glucose levels in such cases is also irrelevant when using HbA1c, because red blood cells have a shorter lifespan in the presence of Hb variants. Glucose monitoring in this condition can be done by periodic glucose examination, fructosamine, or glycated albumin. The HbA1c test cannot be used as a marker of glucose control in patients with hemoglobinopathy E.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"41 2","pages":"141-146"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness Analysis of Triple Oral Antidiabetic Drug Combination in Patients With Type 2 Diabetes Mellitus: An Outpatient Study in Indonesia.","authors":"Izzatu Al Hanifiyah, Yunita Nita, Libriansyah, Achmad Ridwan, Gusti Noorrizka Veronika Achmad","doi":"10.15605/jafes.041.02.6321","DOIUrl":"10.15605/jafes.041.02.6321","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. Initial therapy for type 2 diabetes typically starts with metformin monotherapy, but because of its progressive nature, combination therapy is often required to achieve glycemic targets. However, research on combination therapy with three oral antidiabetic drugs is currently limited.</p><p><strong>Objective: </strong>This study assessed direct medical costs and the cost-effectiveness of a combination of triple oral antidiabetics with first-line metformin combined with glimepiride, pioglitazone, and DPP-4 inhibitors (sitagliptin/vildagliptin), among type 2 DM patients treated in the outpatient clinic of Dr. Ramelan Central Naval Hospital, Surabaya, Indonesia.</p><p><strong>Methodology: </strong>A retrospective cross-sectional analysis was conducted from the hospital perspective using medical records and cost data from January to December 2024. Eligible patients had type 2 DM, received a combination of triple oral antidiabetics with metformin as first-line treatment combined with glimepiride, pioglitazone, and DPP-4 inhibitors (sitagliptin/vildagliptin), attended monthly follow-ups, had at least two HbA1c measurements, and had complete clinical and cost data. Direct medical costs included doctor services, drug acquisition costs, and laboratory monitoring costs.</p><p><strong>Results: </strong>A total of 79 patients were included, 60.8% male, with an average (SD) age of 54.9 (9.26) years, and 69.6% with comorbidities. Compared with the combination of metformin + glimepiride + pioglitazone, the combination of metformin + sitagliptin/vildagliptin + glimepiride and metformin + sitagliptin/vildagliptin + pioglitazone was more cost-effective, with ICER values of IDR -162,119.77; IDR 845,655.5, respectively. Both ICER values were below the willingness-to-pay (WTP) threshold. One-way sensitivity analysis showed that the model results were relatively robust to parameter variations of ±20%. In the combination of metformin + sitagliptin/vildagliptin + glimepiride vs metformin + glimepiride + pioglitazone, laboratory monitoring costs had the greatest influence on the ICER value. Meanwhile, the combination comparison metformin + sitagliptin/vildagliptin + pioglitazone vs metformin + glimepiride + pioglitazone was most sensitive to changes in effectiveness (ΔHbA1c).</p><p><strong>Conclusion: </strong>Metformin + sitagliptin/vildagliptin + glimepiride and metformin + sitagliptin/vildagliptin + pioglitazone are both more cost-effective compared to metformin + glimepiride + pioglitazone in this setting.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"41 2","pages":"68-74"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Sodium-Glucose Cotransporter 2 Inhibitors on Peripheral Nerves and Skeletal Muscle Function in Type 2 Diabetes.","authors":"Lakshani Dhananjanee Malwatta, Sampath Gunawardena, Vimukthi Rananjaya Senanayake, Isuru Jayasanka Thabrew","doi":"10.15605/jafes.041.02.6193","DOIUrl":"10.15605/jafes.041.02.6193","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes is one of the four main non-communicable diseases in Sri Lanka with prevalence of 26%. SGLT2 inhibitors, primarily used for glycaemic control in type 2 diabetes, have recently garnered attention for their potential effects on neuromuscular function. The primary objective of this scoping review was to map the existing literature to determine the extent, range and nature of published evidence on the effects of SGLT2 inhibitors on peripheral nerve morphology, electrophysiology and skeletal muscle function and metabolic kinetics.</p><p><strong>Methodology: </strong>Guided by the PRISMA extension for Scoping Reviews (PRISMA-ScR), an electronic search was executed across PubMed, ScienceDirect and Google Scholar for literature published from 2010 onwards. Applying a strict Population-Concept-Context (PCC) framework, two independent reviewers screened and analyzed studies evaluating human populations or corresponding animal models with T2DM (Population) undergoing SGLT2 inhibitor therapy (Concept), in relation to somatic/autonomic nerve conduction, nerve histology, muscle mass and metabolic processing (Context). Data extraction charted study characteristics, species, specific drug types, duration of effect and symptom relief versus electrophysiological outcomes.</p><p><strong>Results: </strong>Thirty-two studies met the inclusion criteria with 16 evaluating peripheral nerves and 16 focusing on skeletal muscle kinetics. Evidence from animal models and human trials suggests potential improvements in peripheral nerve conduction velocity (NCV), epidermal nerve fiber density, skeletal muscle substrate flexibility, toward fatty acid and ketone oxidation, and mitochondrial structural dynamics. However, divergent and neutral functional outcomes, particularly in human muscle grip strength and short-term versus long-term clinical symptom recovery-were observed, highlighting critical knowledge gaps.</p><p><strong>Conclusion: </strong>SGLT2 inhibitors demonstrate promising neuroprotective and myo-metabolic modulating properties via multiple pathways. However, the current literature is heavily geared towards animal models, with clear knowledge gaps on long-term effects on human function and symptom improvement. This review provides a mapped baseline to guide future targeted clinical trials.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"41 2","pages":"98-108"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-Guided Skin and Subcutaneous Fat Thickness Profiling for Insulin Delivery in Overweight and Obese Adults With Type 2 Diabetes: A Cross-Sectional Malaysian Study.","authors":"Chiawoon Tai, Yusuhaimi Remli, Madihah Nasuha Yunus","doi":"10.15605/jafes.041.02.6339","DOIUrl":"10.15605/jafes.041.02.6339","url":null,"abstract":"<p><strong>Background: </strong>Safe insulin administration requires delivery into the subcutaneous tissue to avoid intradermal or intramuscular injection. Although international guidelines recommend the universal use of 4 mm needles, local anatomical data supporting this recommendation among overweight and obese adults with type 2 diabetes mellitus (T2DM) in Malaysia are limited.</p><p><strong>Objective: </strong>To assess skin thickness (ST) and subcutaneous adipose tissue (SAT) using ultrasound to evaluate the safety of 4 mm insulin needles in overweight and obese adults.</p><p><strong>Methodology: </strong>This cross-sectional study involved 98 adults with T2DM on insulin therapy (body mass index [BMI] ≥23 kg/m²) attending a primary care clinic in Johor Bahru, Malaysia. ST and SAT at 10 abdominal injection sites and 8 upper arm injection sites were measured using ultrasonography. Data were analyzed using descriptive statistics, correlation tests, and multiple linear regression to identify associations with BMI, age, gender, and other variables.</p><p><strong>Results: </strong>The median abdominal ST was 2.46 mm (interquartile range [IQR]: 2.20-2.80), and upper arm ST was 1.92 mm (IQR: 1.73-2.11). Only 6.1% of participants had any site with ST greater than 4 mm. Median abdominal SAT was 16.75 mm (IQR: 14.83-19.28), and upper arm SAT was 15.38 mm (IQR: 12.10-17.73). Multiple linear regression showed that abdominal ST was significantly predicted by BMI (β = 0.244, <i>p</i> = 0.015) and inversely by age (β = -0.202, <i>p</i> = 0.040). Gender was the strongest predictor of upper arm ST (β = -0.418, <i>p</i> <0.001), with females having thinner skin. Abdominal SAT was positively associated with BMI (β = 0.469, <i>p</i> <0.001) and male gender (β = -0.205, <i>p</i> = 0.026), suggesting that BMI may serve as a useful clinical indicator of abdominal injection depth. No significant predictors were found for upper arm SAT.</p><p><strong>Conclusion: </strong>Most overweight and obese Malaysian adults with T2DM have adequate ST and SAT for safe insulin delivery using 4 mm pen needles. Ultrasonographic data support individualized injection technique education in primary care, considering BMI, gender, and age.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"41 2","pages":"60-67"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Islet Autoantibody and Beta Cell Secretory Status at Diagnosis in Young Bangladeshi with Phenotypically Type 2 Diabetes.","authors":"Kishore Kumar Shil, Mashfiqul Hasan, Nusrat Sultana, Sayad Bin Abdus-Salam, Hafsa Mahrukh, Tahmina Ferdousi, Muhammad Abul Hasanat","doi":"10.15605/jafes.041.01.5033","DOIUrl":"10.15605/jafes.041.01.5033","url":null,"abstract":"<p><strong>Background: </strong>The overlapping clinical features in young-onset type 2 diabetes (T2DM) present significant diagnostic difficulties. Variable autoimmunity and beta-cell dysfunction, which are related to the phenomenon, are not sufficiently consolidated to distinguish subclasses.</p><p><strong>Objectives: </strong>To determine the frequency of islet autoantibodies and beta-cell secretory status in phenotypically young Bangladeshi with T2DM.</p><p><strong>Methodology: </strong>This cross-sectional study enrolled 83 patients with newly diagnosed young-onset phenotypically T2DM, aged 10 to 29 years, comprising 34 males (41%) and 48 females (59%), using non-probability purposive sampling. The demographic and clinical features of the patients were recorded. A fasting blood sample was collected for C-peptide and islet antibodies (anti-glutamic acid decarboxylase [GAD], zinc transporter 8 [ZnT8], and Islet Antigen 2 [IA-2] antibodies). C-peptide, anti-GAD Ab and IA-2 Ab were measured by chemiluminescence, while the ZnT8 Ab was measured by enzymelinked immunosorbent assay (ELISA).</p><p><strong>Results: </strong>An adequate beta cell secretory reserve was present in 97.6% of participants (N = 82), with a median C-peptide level of 4.3 ng/mL (IQR: 3.0-6.7). Of the 82 patients included, GAD Ab was found to be positive in 17% (n = 14), ZnT8 Ab in 2.4% (n = 2), and none were positive for IA-2 Ab or a double antibody (ZnT8 Ab + GAD Ab). The frequency of double diabetes (DD) [GAD Ab positive subjects] was 17% (14/82). Comparing the GAD Ab positive to the negative group, the former had a significantly lower homeostasis model assessment of β-cell function (HOMA-B) at 24.7 (16.3-99.1) [versus 81.9 (30-154) in the latter (<i>p</i> = 0.02)] and a significantly higher fasting plasma glucose (FPG) median IQR at 16 mmol/L (10-19) [compared to 9.5 (6.7-14.5) (<i>p</i> = 0.04) in the negative group.] The body mass index (BMI) was the only significant predictor of C-peptide (β = 0.44, <i>p</i> <0.001).</p><p><strong>Conclusion: </strong>GAD Ab was the most commonly detectable antibody in this study of young-onset phenotypically T2DM patients. The concentration of GAD Ab may influence the phenotypic presentation, but it is not a predictor of C-peptide levels. Beta-cell dysfunction in this subset of patients may depend on certain yet unexplored factors.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"41 1","pages":"10-17"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Baseline HbA1c and Inpatient Glycemic Control on Mortality and Organ Dysfunction among Patients with Diabetes Mellitus Hospitalized for COVID-19: A Multicenter Retrospective Cohort Study.","authors":"Mari Des San Juan, Jennifer Lourdes Ng, John Paul Martin Bagos, Marion Sarigumba, Jekrylei Cadeliña, Ronald Chua, Darius Enario, Margarita Katrina Amor Tan, Elizabeth Paz-Pacheco, Sahra May Paragas, Erick Mendoza, Maria Princess Kanapi, Christina Chua, Cindy Ceryl Tan, Cecille Dela Paz, Karla Kristine Fernando","doi":"10.15605/jafes.041.01.5089","DOIUrl":"10.15605/jafes.041.01.5089","url":null,"abstract":"<p><strong>Background: </strong>Individuals with diabetes mellitus (DM) show increased susceptibility to COVID-19 infection with higher risk for severe disease and mortality.</p><p><strong>Objectives: </strong>We investigated whether glycemic-related factors may affect the outcomes of patients with DM hospitalized due to COVID-19.</p><p><strong>Methodology: </strong>This is a multicenter retrospective cohort study under the initiative of the Philippine College of Endocrinology, Diabetes, and Metabolism involving eight training hospitals in the Philippines from January 2021 to January 2022. Patients with DM hospitalized due to COVID-19 were included. Univariable and multivariable analyses were done to determine whether baseline glycemic control based on glycosylated hemoglobin (HbA1c) and inpatient glycemic control based on capillary blood glucose are associated with composite poor clinical outcome of mortality and end-organ dysfunction.</p><p><strong>Results: </strong>Among 1,093 patients, 54% had HbA1c >7%. Critical COVID-19 disease was greater in patients with poor baseline glycemic control (28.43% vs 19.72%, <i>p</i> = 0.001) and poor inpatient glycemic control (25.7% vs 12.64%, <i>p</i> <0.001). Both poor baseline glycemic (AOR 1.41, <i>p</i> = 0.017) and poor inpatient glycemic control (AOR 2.6, <i>p</i> <0.001) were associated with composite poor clinical outcome of mortality and end-organ dysfunction after adjusting for each other, but lost significance after adjusting for age, COVID-19 severity, and presence of comorbidities. COVID-19 severity had the greatest association with composite poor clinical outcome after adjusting for all other variables. HbA1c >7% increased the odds of poor inpatient control (OR = 3.10, 95% CI: 2.32-4.17, <i>p</i> <0.001), even after adjusting for steroid use.</p><p><strong>Conclusion: </strong>COVID-19 severity had the greatest impact and is the only variable with a statistically significant association with composite poor clinical outcomes after adjusting for all other variables. Poor glycemic control on admission and during hospitalization were associated with more severe COVID-19, although they did not directly impact clinical outcomes. Measures to optimize glycemic control both in the long term and during hospitalization should be considered to prevent severe COVID-19, hence improving clinical outcomes and survival.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"41 1","pages":"60-70"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Enzyme Biomarkers Before or in Early Pregnancy as Predictors for Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis.","authors":"Samuel Pratama, Rizka Dwi Aulia, Indi Jazilah, Brigitta Cindy Lauren","doi":"10.15605/jafes.041.01.5807","DOIUrl":"10.15605/jafes.041.01.5807","url":null,"abstract":"<p><strong>Background: </strong>Liver enzymes may reflect early metabolic disturbances and insulin resistance preceding gestational diabetes mellitus (GDM). This systematic review and meta-analysis evaluated whether liver enzyme biomarkers measured before or in early pregnancy are associated with subsequent development of GDM.</p><p><strong>Methodology: </strong>PubMed, Cochrane, EBSCOHost, and SCOPUS databases were searched through May 2025 for observational studies or trials assessing pre- or early pregnancy liver enzymes in relation to GDM development. Pooled mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. Risk of bias was assessed using RoB 2.0 and ROBINS-E; certainty of evidence was evaluated using GRADE.</p><p><strong>Results: </strong>Twenty-seven studies were included in the analyses. GDM was associated with higher AST (MD 0.97 U/L; OR 1.42), ALT (MD 2.38 U/L; OR 1.69), GGT (MD 3.77 U/L; OR 2.57), and hepatic steatosis index (HSI) (MD 2.82; OR 2.19). ALP showed no significant mean difference but an elevated GDM risk (OR 1.47). Substantial heterogeneity was observed with very low certainty of evidence across outcomes.</p><p><strong>Conclusion: </strong>Elevated liver enzymes, especially GGT and HSI, are associated with increased GDM risk at a population level. However, high heterogeneity and very low certainty of evidence limit current clinical applicability, warranting further prospective validation.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"41 1","pages":"170-185"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Chronic Kidney Disease on Ulcer-Related Outcomes in Hospitalized Diabetic Foot Ulcers: A Retrospective Study from Thailand.","authors":"Jeeraphan Sripatpong, Sirinate Krittiyawong, Waralee Chatchomchuan, Ekgaluck Wanothayaroj, Taweesak Srikummoon, Poovasit Klinoubol, Phawinpon Chotwanvirat, Siriwan Butadej, Soontaree Nakasatien, Thep Himathongkam, Yotsapon Thewjitcharoen","doi":"10.15605/jafes.041.01.5197","DOIUrl":"10.15605/jafes.041.01.5197","url":null,"abstract":"<p><strong>Objective: </strong>To explore the impact of chronic kidney disease (CKD) on hospitalized patients with diabetic foot ulcers (DFU) at a tertiary diabetes center in Thailand.</p><p><strong>Methodology: </strong>A retrospective study reviewed hospitalized DFU admissions at Vimut-Theptarin Hospital from 2019 to 2023. Ulcer-related outcomes included complete wound healing at 12 months, major and minor amputations, and 1-year mortality.</p><p><strong>Results: </strong>A total of 265 DFU admissions from 225 patients were included (male 60.4%; age, 66.7 ± 13.4 years; A1C, 8.2 ± 2.3%, advanced CKD, 26.1%, peripheral arterial disease, 54.7%). Severe DFU (Wagner grade ≥3) comprised 60.0% of all DFUs and almost one-third of patients had prior amputations. Complete healing occurred in 69.8%; major amputation in 4.9%; minor amputation in 30.9%; and 1-year mortality rate after discharge was 11.7%. Advanced CKD (stages 4-5) increased odds of non-healed ulcers (odds ratio OR, 2.69; 95% confidence interval CI, 1.46-4.98; <i>P</i> = 0.002) and 1-year mortality rate (21.7% vs 8.4%; <i>P</i> = 0.004).</p><p><strong>Conclusion: </strong>Advanced chronic kidney disease (CKD) is associated with poorer ulcer-related outcomes in hospitalized patients with diabetic foot ulcers (DFU). Proactive foot care and early referral to multidisciplinary teams, particularly for dialysis-dependent patients, remain essential. Despite ongoing advances in DFU management, these patients continue to face higher rates of non-healing ulcers and mortality, underscoring the need for coordinated inter-institutional care and enhanced public education efforts.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"41 1","pages":"32-39"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Ramadan Fasting on Relative Leukocyte Telomere Length in Type 2 Diabetes Mellitus.","authors":"Mona Hardika, Farid Kurniawan, Purwita Wijaya Laksmi, Syahidatul Wafa, Rheza Meida Marliau, Agian Jeffilano Barinda, Dante Harbuwono, Dicky Tahapary","doi":"10.15605/jafes.041.01.5071","DOIUrl":"10.15605/jafes.041.01.5071","url":null,"abstract":"<p><strong>Background: </strong>Leukocyte telomere length (LTL) is considered a biomarker of cellular senescence. Previous studies have reported the associations between shortened telomere length and type 2 diabetes mellitus (T2DM). However, the role of underlying factors remained unclear. While Ramadan fasting has consistently been shown to improve anthropometric and metabolic parameters in T2DM, its effect on cellular senescence has scarcely been reported.</p><p><strong>Objective: </strong>We sought to determine whether Ramadan Fasting affects leukocyte telomere length in persons with T2DM.</p><p><strong>Methodology: </strong>An interventional before-and-after study was conducted on 40 to 60-year-old subjects with T2DM consecutively recruited before Ramadan fasting (May 2018 and May 2019) from the Internal Medicine Outpatient Clinic at Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. Relative LTL was compared between 48 subjects before Ramadan fasting and after at least 14 days of fasting and then adjusted with key clinical and biochemical parameters.</p><p><strong>Results: </strong>The relative rLTL in subjects with T2DM was comparable between before and after at least 14 days of Ramadan fasting. (0.391 [0.021-1.515] vs 1.117 [0.528-1.741], <i>p</i> = 0.112).</p><p><strong>Conclusion: </strong>No significant difference was found in relative leukocyte telomere length among subjects with type 2 diabetes who have undergone Ramadan fasting for at least 14 days. However, this study showed a tendency to have an increase in relative LTL.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"41 1","pages":"101-107"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Infection and Gut Microbial Dysbiosis Among Filipinos with Type 2 Diabetes Mellitus.","authors":"Adrian Jonathan Velasco, Leslie Michelle Dalmacio","doi":"10.15605/jafes.041.01.6343","DOIUrl":"10.15605/jafes.041.01.6343","url":null,"abstract":"<p><strong>Background: </strong>Both type 2 diabetes mellitus (T2DM) and COVID-19 are associated with gut microbial alterations. It remains unclear whether COVID-19 causes further gut dysbiosis among individuals with T2DM.</p><p><strong>Objective: </strong>This study aimed to characterize the gut microbiome of Filipinos with T2DM who had COVID-19.</p><p><strong>Methodology: </strong>101 Filipinos, aged 30-59, residing in the Greater Manila Area, were recruited into one of four groups: non-COVID/non-T2DM (A), COVID-recovered/non-T2DM (B), non-COVID/T2DM (C), and COVID-recovered/T2DM (D). Gut microbial composition was characterized through 16S rRNA gene profiling of stool samples using Illumina MiSeq-nextgeneration Sequencing. These sequences were subjected to mothur and PICRUSt2 for taxonomic and functional analyses.</p><p><strong>Results: </strong>Gut microbial analysis revealed potential disease biomarkers, as <i>Roseburia</i> is more abundant among participants with COVID-19 history, while <i>Parabacteroides</i> is more abundant among participants with T2DM. Principal coordinate analysis (PCOA) revealed that participants with T2DM clustered together, while participants without T2DM displayed significantly different clustering.</p><p><strong>Conclusion: </strong>These findings suggest that COVID-19 does not cause further gut dysbiosis among individuals with T2DM and that T2DM exerts a stronger influence on the gut microbiome compared to COVID-19. These findings are useful for clinicians to better understand the COVID-19 risk to T2DM.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"41 1","pages":"72-81"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}