Journal of the ASEAN Federation of Endocrine Societies最新文献

Background: The recent COVID-19 pandemic has led to a rise in the incidence of obesity both in children and adults. Studies on the effect of the pandemic on Type 2 diabetes mellitus (T2DM) trends in children are limited. In this study, we aim to evaluate the frequency, clinical characteristics and demographics of newly-diagnosed paediatric T2DM cases 4 years before and after the pandemic.

Methodology: The frequency and clinical data of patients aged ≤18 years with newly-diagnosed T2DM in 4 tertiary centers in urban Malaysia from 18 March 2016 until 17 March 2020 (pre-pandemic) and 18 March 2020 until 17 March 2024 (postpandemic) was collected.

Results: Seventy-five (75) patients were recorded with newly-diagnosed T2DM pre-pandemic and fifty-four (54) patients were recorded with newly-diagnosed T2DM post-pandemic. There was no significant increase in T2DM cases and diabetic ketoacidosis (DKA) during pandemic and T2DM cases fell to below pre-pandemic levels in the 3^rd and 4^th year post-pandemic. HbA1c and serum glucose were lower post-pandemic than pre-pandemic: 10.1% vs 11.9%, p = 0.008 and 12.0 mmol/L vs 16.1 mmol/L, p = 0.038 respectively.

Conclusion: The incidence of T2DM and DKA did not increase during the pandemic and further declined in year 3 and 4 post-pandemic. Lower HbA1c and serum glucose in the post-pandemic group may suggest improved screening services and greater access to medical care.

Background: Despite the beneficial effects of SGLT2i in reducing kidney disease progression and mortality in people with diabetic kidney disease (DKD), the use of SGLT2i in this population remains low.

Objective: To explore the prescription rates of SGLT2i in type 2 diabetes (T2D) patients with albuminuric DKD and to assess clinician-perceived barriers to prescribing SGLT2i.

Methodology: A retrospective study of all medical records of T2D patients with albuminuric DKD and eGFR ≥20 ml/min/1.73m² in 2023 who had been treated by 13 diabetologists was conducted at Vimut-Theptarin Hospital, a private tertiary diabetes center in Bangkok. In cases of no documentation of non-prescribed SGLT2i, treating physicians were contacted to explore the reasons.

Result: A total of 282 medical records were reviewed (mean age 65.9 ± 10.0 years, A1C 7.5 ± 1.2 %, duration of diabetes 19.7 ± 10.4 years, mean eGFR 68.3 ± 24.1 mL/min/1.73 m², median UACR 151 (IQR 309) mg/g Cr, RAS inhibitors usage 80.1%). The SGLT2i prescription rate was 58.9% in 2023. Coronary artery disease, age ≥65 years, eGFR <60 mL/min/1.73 m², optimal A1C and LDL control, use of thiazolidinedione were associated with SGLT2i prescription. Clinical inertia (31.9 %) was the most common reason for not prescribing SGLT2i in eligible patients, followed by cost concerns (18.1%) and frailty of patients (15.5%).

Conclusion: Prescribing SGLT2i to T2D patients with albuminuric DKD remains suboptimal among diabetologists due to clinical inertia, medication costs, and frailty. Our study underscores actions aimed at improving SGLT2i prescription rates in routine practice.

Objectives: Diabetic ketoacidosis (DKA) is the most common initial presentation in children with newly diagnosed type 1 diabetes. Severe dehydration/acidosis, shock at admission, and hyperchloremia contribute to acute kidney injury (AKI). This retrospective study was done to determine the proportion of children hospitalized for DKA who had AKI and to compare clinical parameters between DKA children with AKI and without AKI to identify the risk factors associated with AKI.

Methodology: A retrospective review of all DKA admissions with type 1 diabetes was done. AKI was diagnosed as per KDIGO-2012 criteria. The analysis was done using a Chi-square test to assess the association between the status of AKI and other parameters. The Independent t-test was applied for comparison with the mean score between the No AKI / AKI group for numerical variables with normal distribution. A multivariate logistic regression analysis was performed to compare clinical parameters between both groups.

Results: Out of 32 children with DKA, 13 (40.63%) developed AKI. Among them, 9 had AKI at admission and 4 children developed AKI within the first 48 hours of admission. Optimum fluid management resolved AKI in 10 patients, but 3 of them required dialysis. Parameters like higher heart rate (p = 0.0390), higher respiratory rate (p = 0.0402), high leukocyte count (p = 0.0005), severe hyperglycemia (p = 0.0204), severe acidosis (p = 0.0001), hyperchloremia (p = 0.016) and shock at admission (p = 0.0001) were present in children with DKA and AKI.

Conclusion: In our study, a high proportion of children with DKA had AKI, which causes prolonged acidosis and hospital stay. Hence, comparing clinical parameters between both groups helps in identifying risk factors associated with AKI in persons with type 1 diabetes with DKA.

Introduction: Cardiac Autonomic Neuropathy (CAN) is frequently an underdiagnosed consequence of Diabetes Mellitus (DM), increasing the risk of cardiac arrhythmia, silent myocardial ischemia and sudden cardiac death. Diabetic Peripheral Neuropathy (DPN) is a common consequence of diabetes. We aimed to study the proportion of CAN among patients with DPN and identify the predictors of CAN in these patients.

Methodology: This is a hospital-based cross-sectional study conducted over a six-month period. A total of 60 DM patients with nerve conduction study-proven DPN, who fulfilled the inclusion and exclusion criteria, were enrolled in the study. CAN was assessed using both parasympathetic and sympathetic tests. A p-value of <0.05 was considered significant.

Results: The study included a total of 60 patients with diabetic peripheral neuropathy, out of whom 19 (32%) had CAN. Out of the 19 patients with CAN, 11 had severe CAN. There was no statistically significant association between the severity of DPN and CAN (p = 0.162). Logistic regression analysis (Model 3) showed that when adjusted for symptoms, risk factors, hypertension and a specific ECG finding (left atrial enlargement), the determinants of CAN were the presence of motor symptoms, being overweight or obesity and the presence of left atrial enlargement.

Conclusion: Among this cohort of persons with DM who all had DPN, CAN was found in one-third (32%) of the sample. Patients with DPN who are overweight/obese, have motor neuropathy or have left atrial enlargement have the most significant risk for developing CAN and may be recommended for its screening. Given that CAN is a frequently overlooked condition, each early diagnosis of CAN may potentially prevent its debilitating complications and even fatal outcomes.

Objectives: Non-alcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease, especially in patients with type 2 diabetes mellitus (T2DM). Significant prevalence of liver fibrosis has been observed in Indian diabetic patients with fatty liver. Early detection of liver fibrosis in persons with diabetes prevents serious problems. This study compares non-invasive liver fibrosis scores and vibration-controlled transient elastography (VCTE) utilising FIBROSCAN™ to assess fibrosis prevalence in patients with T2DM and NAFLD.

Methodology: This cross-sectional, observational study enrolled 351 patients with T2DM and NAFLD from September to October 2023 from eight West Bengal diabetes facilities. Liver stiffness measurement (LSM) via VCTE was used to detect fibrosis. Non-invasive tests (NITs), including fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), fibrotic NASH-index (FNI), and AST to platelet ratio index (APRI) were also calculated. To evaluate NIT diagnostic performance, AUROC curve calculations were used.

Results: Among patients with T2DM, 26.5% had fibrosis and 3.13% of individuals had advanced fibrosis (≥F3), whereas 11.97% had substantial fibrosis (≥F2). Fibrotic NASH-index could detect fibrosis best with area under the curve (AUROC) >0.70, whereas FIB-4 and NFS were better (AUROC >0.8) to identify advanced fibrosis, and APRI struggle to diagnose severe fibrosis.

Conclusion: In patients with T2DM with NAFLD, VCTE detects fibrosis. FNI is best tool for detection of fibrosis, whereas FNI and NFS are better for distinguishing advanced fibrosis in such patients. To increase fibrosis identification in this population, multiple diagnostic approaches are needed.

Introduction: Metformin is a commonly used anti-diabetic drug due to its safety, low cost, and strong glucose-lowering effects. Recent research studies have identified novel molecular targets and pathways for metformin, thereby expanding its potential beyond the treatment of Type 2 diabetes.

Methodology: This systematic review provides the latest updates on the therapeutic applications of metformin in multiple diseases. This systematic review follows the PRISMA guidelines, focusing on experimental studies systematic reviews and meta-analyses from PubMed, Scopus, Web of Science and Google scholar, the search terms ("Metformin"[MeSH] OR "Metformin") AND ("Cancer" OR "Cardiovascular Disease" OR "Neurodegenerative Disease" OR "Aging") AND ("Therapeutic Use" OR "Non-diabetic"). A comprehensive search yielded numerous studies, from which relevant and up-to-date papers were carefully selected.

Results: The review highlights the multifaceted applications of metformin in various diseases. Evidence demonstrates its positive effects on cardiovascular diseases, obesity, different types of cancer, and liver and kidney disorders. These findings suggest that metformin acts through diverse molecular mechanisms, exerting benefits that extend beyond glycemic control.

Conclusion: Based on the current literature, metformin exhibits a broad spectrum of therapeutic benefits, extending beyond its primary use in diabetes management. Its role in treating multiple diseases has marked it as a multifaceted agent in modern medicine. Further research is warranted to fully explore its capabilities and optimize its use in different clinical settings.

Objectives: Gestational diabetes mellitus (GDM), a pregnancy-induced hyperglycemia, affects approximately 17% of pregnancies globally. Its pathophysiology remains unclear, with inflammation and vascular remodeling playing key roles. CD248, a glycoprotein linked to inflammation and vascular remodeling, has been implicated in various conditions, but its role in GDM is uncertain.

Methodology: A prospective case-control study was conducted with 169 pregnant women aged 18 to 49 at a tertiary hospital. Serum CD248 levels were assessed at 24 to 28 weeks of gestation prior to the oral glucose tolerance test (OGTT). Statistical analyses evaluated the association between CD248 levels, BMI and GDM status.

Results: Of the participants, 32 (18.9%) were diagnosed with GDM. CD248 levels were lower in GDM patients (8.15 ± 10.16 ng/mL) than in controls (11.42 ± 15.44 ng/mL), but the difference was not statistically significant (p = 0.084). Although CD248 levels did not correlate with OGTT values, it was positively associated with BMI (p <0.001).

Conclusion: Unlike earlier findings associating elevated CD248 levels with early pregnancy GDM risk, this study found no significant relationship during later gestational stages. These results highlight a potentially complex and context-dependent role for CD248 in GDM pathophysiology.