Journal of the ASEAN Federation of Endocrine Societies
The Journal of the ASEAN Federation of Endocrine Societies (JAFES) is an open-access, peer-reviewed, English language, medical and health science journal that is published three times a year by the ASEAN Federation of Endocrine Societies (AFES). Its editorial policies are aligned with the policies of the International Committee of Medical Journal Editors (www.icmje.org), and resolve ethical issues using recommendations and guidelines of the Committee on Publication Ethics (COPE). It is a member of the World Association of Medical Editors (WAME) and CrossRef. JAFES welcomes manuscripts on all aspects of endocrinology and metabolism in the form of original articles, review articles, case reports, feature articles (clinical practice guidelines, clinical case seminars, book reviews, et cetera), editorials, letters to the Editor, brief communications and special announcements. Authors may include members and non-members of the AFES. JAFES is indexed in the following international indexes
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Islet Autoantibody and Beta Cell Secretory Status at Diagnosis in Young Bangladeshi with Phenotypically Type 2 Diabetes
*]:pointer-events-auto [content-visibility:auto] supports-[content-visibility:auto]:[contain-intrinsic-size:auto_100lvh] R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:e97a8ee1-6cf3-469e-ae15-03becd7032d4-6" data-testid="conversation-turn-14" data-scroll-anchor="false" data-turn="assistant"> Background. The overlapping clinical features in young-onset type 2 diabetes (T2DM) present significant diagnostic difficulties. Variable autoimmunity and beta-cell dysfunction related to this phenomenon are not sufficiently consolidated to distinguish subclasses. Objectives. To determine the frequency of islet autoantibodies and beta-cell secretory status in phenotypically young Bangladeshis with T2DM. Methodology. 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 ZnT8 Ab was measured by enzyme-linked immunosorbent assay (ELISA). Results. 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 and negative groups, 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 (p = 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) (p = 0.04) in the negative group. The body mass index (BMI) was the only significant predictor of C-peptide (β = 0.44, p < 0.001). Conclusion. 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.
Copyright (c) 2026 Kishore Kumar Shil, Mashfiqul Hasan, Nusrat Sultana; Sayad Bin Abdus-Salam, Hafsa Mahrukh; Tahmina Ferdousi, Muhammed Abul Hasanat http://creativecommons.org/licenses/by-nc/4.0
Direct Medical Cost Analysis of Hyperglycemic Emergencies Among Patients with Diabetes Mellitus in a Tertiary Government Hospital in the Philippines
*]:pointer-events-auto [content-visibility:auto] supports-[content-visibility:auto]:[contain-intrinsic-size:auto_100lvh] R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:e4a3ed06-6036-4e76-84bc-224df19dc42a-9" data-testid="conversation-turn-20" data-scroll-anchor="false" data-turn="assistant"> Background. There is limited published local data on the direct medical costs of hyperglycemic emergencies. This study aimed to analyze direct medical costs incurred during hospitalization for hyperglycemic emergencies from a healthcare payer perspective. Methodology. This is a retrospective cohort study done in a tertiary government hospital in the Philippines. The primary outcome measure was the median cost and distribution of direct medical costs (in Philippine Pesos) incurred during hospitalization. Results. Among 319 patients with cost data, the median direct medical cost was PhP 79,331.50 (USD 1,375.02; USD 1: PhP 57.69), representing approximately 22.5% of the average annual family income and 7.2 times the average annual healthcare expenditure per capita. HHS incurred the highest costs (PhP 143,902.77; USD 2,494.21) with diagnostic fees as the largest expense (PhP 41,507.00; USD 719.42). The total costs exceeded the coverage provided by PhilHealth, the national health insurance in the Philippines. Socioeconomic disparities were evident, with lower-income patients incurring higher expenses due to delayed presentation and more severe illness. Conclusion. This study highlights the substantial economic burden of hyperglycemic emergencies in a public tertiary hospital. As one of the first of its kind locally, the study informs policy efforts to reduce financial risk for vulnerable populations and optimize resource allocation for diabetes-related emergencies.
Copyright (c) 2026 Juan Paolo Abasolo, Aldrich Ivan Lois Burog, Margarette Rose Pajanel, Emilio III Villanueva, Celito Tamban http://creativecommons.org/licenses/by-nc/4.0
The Impact of Chronic Kidney Disease on Ulcer-Related Outcomes in Hospitalized Diabetic Foot Ulcers
Objective. To explore the impact of chronic kidney disease (CKD) on hospitalized patients with diabetic foot ulcers (DFU) at a tertiary diabetes center in Thailand. Methodology. 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. Results. 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 the 1-year mortality rate after discharge was 11.7%. Advanced CKD (stages 4–5) increased the odds of non-healed ulcers (odds ratio [OR] 2.69; 95% confidence interval [CI] 1.46–4.98; P = 0.002) and 1-year mortality (21.7% vs 8.4%; P = 0.004). Conclusion. 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.
Copyright (c) 2026 Jeeraphan Sripatpong, Sirinate Krittiyawong , Waralee Chatchomchuan , Ekgaluck Wanothayaroj, Taweesak Srikummoon, Poovasit Klinoubol , Phawinpon Chotwanvirat, Siriwan Butadej, Soontaree Nakasatien, Thep Himathongkam, Yotsapon Thewjitcharoen http://creativecommons.org/licenses/by-nc/4.0
Knowledge, Attitudes and Practices of Physicians on Diagnosis and Management of Diabetic Peripheral Neuropathy at the University of Santo Tomas Hospital
*]:pointer-events-auto [content-visibility:auto] supports-[content-visibility:auto]:[contain-intrinsic-size:auto_100lvh] R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:d6f3c1d4-f17c-4bf0-8943-a79f0faa1b34-6" data-testid="conversation-turn-14" data-scroll-anchor="false" data-turn="assistant"> Background. Diabetic peripheral neuropathy (DPN) is a prevalent chronic complication of diabetes, resulting in significant morbidity and mortality. Despite its impact, DPN remains an underdiagnosed and undertreated entity, further underscoring the need for improved physician awareness and timely intervention. Objective. The study aimed to determine physicians’ knowledge, attitudes and practices (KAP) in the diagnosis and management of DPN and the association between knowledge and attitude to practice. Methodology. This was a cross-sectional study involving 211 physicians from the University of Santo Tomas Hospital (USTH). Chi-square test was employed to compare physician characteristics based on KAP. The association of knowledge and attitude with practice regarding DPN was analyzed using multiple logistic regression analysis. Result. Median knowledge level was 81.3%, indicating good knowledge on DPN diagnosis and management. Most had favorable attitude and reported appropriate practice. Only attitude was shown to be significantly associated with practice. Conclusion. Despite good knowledge about DPN, attitude was the only key influencer on appropriate practice. Enhancing positive attitudes in screening and management is essential to improve patient care and outcomes.
Copyright (c) 2026 Samantha Bernardine Reburiano, Dylan Jansen Taytayon, Dionise Ysabelle Bawal, Bien Matawaran http://creativecommons.org/licenses/by-nc/4.0
Guideline-Directed Medical Therapies for Diabetic Kidney Disease Among Thai People With Type 2 Diabetes
Background. The “pillar approach” was recently proposed to holistically address diabetic kidney disease (DKD). Theptarin Diabetes Staging (TDS) is a staging system for type 2 diabetes (T2D) designed to prevent or delay the progression to advanced stages. Objective. To evaluate the rate of guideline-directed medical therapies (GDMT) among individuals with DKD from 2021 to 2025 according to the TDS system. Methodology. A retrospective review of medical records of T2D patients with TDS stage 4Ka (moderately increased persistent albuminuria), Stage 4Kb (severely increased persistent albuminuria), and stage 5Ka (eGFR <45 mL/min/1.73 m²) was conducted. The rates of RASi, SGLT2i, GLP-1 RA, and finerenone use, along with achievement of metabolic targets, were evaluated prospectively from 2021 to 2025. Results. A total of 206 medical records were reviewed (mean age 64.1 ± 10.3 years, A1C 7.3 ± 1.2%, mean eGFR 71.6 ± 24.5 mL/min/1.73 m²). In 2021, the use of RASi was 78.2%, 51.5% for SGLT2i and 13.6% for GLP-1 RA among all patients. Four years later, rates of GDMT improved as follows: RASi 79.7%, SGLT2i 59.3%, GLP-1 RA 19.8% and finerenone 2.8%. However, only 1.1% of all patients in 2025 received all 4 GDMT items. More stable or improved TDS were observed in patients who received GDMT ≥3 classes across all 4 medication classes, compared with those who received GDMT <3 classes (96.2% vs. 78.8%, P-value = 0.036). Conclusion. The real-world implementation of GDMT among DKD patients remains inadequate, and more efforts are required to improve GDMT adoption. Regular reviews and feedback are warranted to improve attainment of treatment targets and better clinical outcomes.
Copyright (c) 2026 Peachaphol Chongvoranond , Waralee Chatchomchuan, Ekgaluck Wanothayaroj , Siriwan Butadej , Soontaree Nakasatien, Thep Himathongkam, Yotsapon Thewjitcharoen http://creativecommons.org/licenses/by-nc/4.0
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
Background. Individuals with diabetes mellitus (DM) show increased susceptibility to COVID-19 infection with higher risk for severe disease and mortality. Objectives. We investigated whether glycemic-related factors may affect the outcomes of patients with DM hospitalized due to COVID-19. Methodology. 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. Multiple binary logistic regression was 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. Results. Among 1,093 patients, 54% had HbA1c >7%. Both poor baseline glycemic (AOR 1.41, p= 0.017) and poor inpatient glycemic control (AOR 2.6, p<0.001) were associated with composite poor clinical outcome of mortality and end-organ dysfunction. HbA1c >7% increased the odds of poor inpatient control (OR = 3.10, 95% CI: 2.32–4.17, p < 0.001), even after adjusting for steroid use. Conclusion. Poor inpatient glycemic control has greater effect on mortality and end-organ dysfunction than baseline glycemic control. However, baseline HbA1c >7% is predictive of poor inpatient glycemic control. Measures to optimize glycemic control both in the long term and during hospitalization will improve clinical outcomes for DM patients with COVID-19.
Copyright (c) 2026 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, Cristina Chua, Cindy Ceryl Tan, Cecille Dela Paz, Karla Kristine Fernando http://creativecommons.org/licenses/by-nc/4.0
COVID-19 Infection and Gut Microbial Dysbiosis Among Filipinos with Type 2 Diabetes Mellitus
*]:pointer-events-auto [content-visibility:auto] supports-[content-visibility:auto]:[contain-intrinsic-size:auto_100lvh] R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:ff0898ea-2523-42a1-aa06-e95bec6fcf26-6" data-testid="conversation-turn-14" data-scroll-anchor="false" data-turn="assistant"> Background. 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. Objective. This study aimed to characterize the gut microbiome of Filipinos with T2DM who had COVID-19. Methodology. 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-next-generation Sequencing. These sequences were subjected to mothur and PICRUSt2 for taxonomic and functional analyses. Results. Gut microbial analysis revealed potential disease biomarkers, as Roseburia is more abundant among participants with COVID-19 history, while Parabacteroides 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. Conclusion. 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.
Copyright (c) 2026 Adrian Jonathan Velasco, Leslie Michelle Dalmacio http://creativecommons.org/licenses/by-nc/4.0
Prevalence and Impact of Hypothyroidism on Glycaemic Control in Indian Patients with Type 2 Diabetes Mellitus
Objectives. This study aimed to determine the prevalence of hypothyroidism in Indian patients with T2DM and explore its impact on glycemic control and comorbidities. Methodology. This cross-sectional study involved 218 patients with T2DM attending a tertiary care centre. Patient demographics, comorbidities, and blood samples were collected to measure glycosylated haemoglobin (HbA1c) and thyroid-stimulating hormone (TSH) levels. Patients were classified as euthyroid, hyperthyroid, or hypothyroid based on TSH levels. A sub-analysis compared demographic and biochemical parameters between euthyroid and hypothyroid groups. Results. The study included 218 patients with T2DM with a mean age of 57.6 ± 11.1 years, and a female predominance (54.1%). The prevalence of hypothyroidism was 58.7%, higher among females. No significant differences in comorbidities or HbA1c levels were observed between euthyroid and hypothyroid patients. Among patients with HbA1c ≥6.4%, women showed a higher prevalence of hypothyroidism. Conclusion. The high prevalence of hypothyroidism among patients with T2DM, particularly in females, underscores the need for routine thyroid function screening in this population. Despite the lack of significant differences in comorbidities or glycaemic control between euthyroid and hypothyroid patients seen in this study, the potential impact of thyroid dysfunction on diabetes management warrants further investigation.
Copyright (c) 2026 J Rawat, Aviral Rawat http://creativecommons.org/licenses/by-nc/4.0
Prevalence and Factors Associated with Diabetes Related Emotional Distress (DRED) Among Filipino Adult Patients with Type 2 Diabetes Mellitus Using A Validated Filipino Version of the Diabetes Distress Scale (DDS)
Background. Diabetes related emotional distress (DRED) is important in diabetes management. There are limited studies involving diabetes distress and its association with glycemic control and other clinicodemographic factors among Filipinos. Objective. This study aimed to translate the Diabetes Distress Scale (DDS) into Filipino and validate this version among Filipino adult patients with type 2 DM and assess the prevalence of DRED and its association with glycemic control and other factors. Methodology. A Filipino DDS was constructed through forward and backward translation of the English version and was validated. A subsequent cross-sectional study was conducted among 186 individuals with type 2 diabetes in a single-center tertiary hospital. The prevalence of DRED and its association with HbA1c level and other related factors were assessed. Results. The overall prevalence of DRED for this study was 34.41% with a mean overall score for the DDS of 2.02. Age (AOR 0.95, 95% CI 0.93–0.98; p = 0.002), higher medication burden, (AOR 1.33, 95% CI 1.01–1.77; p = 0.043) and peripheral artery disease (AOR 6.03, 95% CI 1.79–23.29; p = 0.005) were predictors of DRED. Conclusion. This Filipino version of the DDS showed that it is a valid instrument in the assessment of diabetes related distress among Filipino patients with type 2 diabetes. Diabetes distress scores were not associated with glycemic control. A younger age of diagnosis of diabetes, a history of PAD, and higher medication burden were found to be associated with development of DRED.
Copyright (c) 2026 Carissa Rae Mirano, Oliver Allan Dampil, Hanna Clementine Tan http://creativecommons.org/licenses/by-nc/4.0
The Association of Ramadan Fasting on Relative Leukocyte Telomere Length in Type 2 Diabetes Mellitusc
Background. 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. Objective. We sought to determine whether Ramadan Fasting affects leukocyte telomere length in persons with T2DM. Methodology. 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. Results. 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], p = 0.112). Conclusion. 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.
Copyright (c) 2026 Mona Hardika, Farid Kurniawan, Purwita Wijaya Laksmi, Syahidatul Wafa, Rheza Meida Marliau, Agian Jeffilano Barinda, Dante Harbuwono, Dicky Tahapary http://creativecommons.org/licenses/by-nc/4.0
*]:pointer-events-auto [content-visibility:auto] supports-[content-visibility:auto]:[contain-intrinsic-size:auto_100lvh] R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:e4a3ed06-6036-4e76-84bc-224df19dc42a-11" data-testid="conversation-turn-24" data-scroll-anchor="false" data-turn="assistant"> Objectives. This sub-analysis of the ACTION APAC study aimed to identify perceptions, attitudes and behaviors related to obesity and its management among people with obesity (PwO) and healthcare providers (HCPs) in the Philippines, identifying barriers to effective care and contributing to management strategies. Methodology. ACTION APAC was a cross-sectional, non-interventional, descriptive survey conducted from April 14 to May 23, 2022 across nine countries, involving 1,000 PwO and 201 HCPs. Results. Most participants agreed that obesity is an illness but 91% of PwO felt losing weight was entirely their responsibility. Both groups identified similar motivators and barriers to weight loss. Weight stigma significantly impacted PwO but fewer than half discussed weight with their HCPs. Many PwO were happy with their weight and did not consider themselves as having obesity. Lifestyle modifications were preferred for weight management by both groups, while HCPs were reluctant to prescribe pharmacotherapy or recommend bariatric surgery due to lack of knowledge and cost, respectively. Conclusion. The study revealed a discrepancy between recognizing obesity as an illness and attitudes towards its treatment, highlighting a need for better education and tailored management strategies that consider cultural factors in the Philippines.
Copyright (c) 2026 Nemencio Nicodemus Jr., Edgardo Juan Tolentino, Cecilia Jimeno, Joy Arabelle Fontanilla, Cyrus Pasamba, Danieson Lampano http://creativecommons.org/licenses/by-nc/4.0
The Prevalence and Risk Factors for Persistent Hyperparathyroidism in Post-Kidney Transplant Patients
Background. Persistent hyperparathyroidism (PHPT) remains a notable challenge among kidney transplant recipients due to its impact on calcium-phosphorus metabolism, potentially hindering recovery and long-term renal function. Understanding its prevalence and risk factors is vital for enhancing patient outcomes. Objective. To determine the prevalence and identify risk factors for persistent hyperparathyroidism in adult Filipino kidney transplant recipients at a tertiary care hospital. Methodology. A retrospective chart review was conducted for 80 kidney transplant recipients at Cardinal Santos Medical Center from January 1, 2014, to July 31, 2024. Data included demographics, comorbidities, medications, and laboratory profiles pre- and post-transplant. Results. Persistent hyperparathyroidism was found in 58.8% of patients. Their mean age was 55.3 years, and 53.8% were male. Hypertension was present in 76.3%, and 60% had diabetes mellitus. Diabetic kidney disease was the leading cause of renal failure (57.5%). Post-transplant use of vitamin D supplements and calcimimetics increased by 31.3% and 26.3%, respectively. Pre-transplant hyperparathyroidism was a key risk factor, with a prevalence of 26.3%. Conclusion. Regular monitoring and management of hyperparathyroidism are essential to improving long-term outcomes in kidney transplant recipients.
Copyright (c) 2026 Pamela Anne Gaerlan, Harold Henrison Chiu, Matt Jayson Fontarum, Jocelyn Cobankiat http://creativecommons.org/licenses/by-nc/4.0
Diagnostic Value of Key Clinical Characteristics and Baseline Cortisol in Assessing Adrenal Function in Patients Receiving Glucocorticoid Therapy
Background. Prolonged glucocorticoid therapy may result in multi-organ complications and adrenal insufficiency (AI). To mitigate these risks, clinicians typically taper and discontinue treatment once the underlying disease is controlled. Prior to withdrawal, adrenal function is assessed through dynamic testing. However, dynamic testing often requires multiple blood samples for cortisol measurement, continuous patient monitoring for several hours, and close supervision by medical staff throughout the procedure to assess potential adverse effects. In addition, dynamic tests are typically costly and not all healthcare facilities are equipped to perform such procedures. Objective. Evaluate the diagnostic performance of baseline cortisol and clinical parameters in the assessment of adrenal insufficiency. Methodology. Cross-sectional study of 96 patients on prolonged glucocorticoid treatment at Nguyen Tri Phuong hospital. Insulin tolerance test (IST) was the gold standard for diagnosis of adrenal insufficiency. Results. Among 96 patients, 56 (58.3%) had AI. A positive correlation was observed between baseline cortisol levels and peak cortisol levels during the insulin tolerance test, demonstrating a moderately strong association (r = 0.62, p <0.001). Baseline cortisol had good diagnostic performance, with areas under the receiver operating characteristic curve (AUROC) of 0.83 [95% confidence interval (CI): 0.78-0.89]. If the optimal cutoff value for morning serum cortisol is set at 9.0 μg/dL, the test demonstrates a sensitivity of 69% and a specificity of 67%. We observed that the morning serum cortisol cutoff of 3 μg/dL had a positive predictive value (PPV) of 100% and the morning serum cortisol cutoff of 15 μg/dL had a negative predictive value (NPV) of 100%. Among the predictive models for AI, the model incorporating baseline characteristics such as Cushingoid appearance, duration of glucocorticoid therapy, history of hypertension, and baseline cortisol demonstrated the highest predictive accuracy, with an AUC of 0.87 (95% CI: 0.80-0.94). Conclusion. The assessment of baseline cortisol in conjunction with baseline characteristics offers a reliable method for predicting the risk of adrenal insufficiency, thereby minimizing the necessity for expensive and intricate dynamic testing. In circumstances where dynamic testing is not feasible due to limitations in resources, cost, or expertise, we advocate for the implementation of a model that incorporates baseline characteristics and cortisol levels. This approach provides a practical, cost-effective solution for evaluating adrenal function, requiring only a single blood sample and ensuring broader accessibility.
Copyright (c) 2026 Dung Truc Nguyen, Tuan Thanh Nguyen, Khanh Quang Tran http://creativecommons.org/licenses/by-nc/4.0
Retrospective Study of Clinical Characteristics, Natural History and Predictive Factors for Mild Autonomous Cortisol Secretion (MACS) in Patients with Adrenal Incidentalomas in Malaysia
*]:pointer-events-auto [content-visibility:auto] supports-[content-visibility:auto]:[contain-intrinsic-size:auto_100lvh] R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:cbbf575c-7dcb-43e6-a391-4d0dc3abf94e-5" data-testid="conversation-turn-12" data-scroll-anchor="false" data-turn="assistant"> Introduction. Adrenal incidentalomas (AIs) are frequently discovered during imaging performed for unrelated conditions. While most are benign and non-functional, a subset demonstrates hormonal activity or malignant potential. This study aimed to describe the clinical and radiological characteristics, natural history and predictors of mild autonomous cortisol secretion (MACS) in a Malaysian cohort. Methodology. This retrospective multicentre study reviewed medical records of 251 patients with AIs from three tertiary hospitals in Malaysia. Data on demographics, imaging findings, hormonal evaluations, histopathological diagnoses and longitudinal follow-up, including serial imaging and hormonal assessments, were collected and analysed. Results. The median age of the cohort was 58 years (IQR 19), with a slight female predominance (53%). The population was predominantly Malay (n = 126, 50.2%), followed by Chinese (36.3%) and Indian (12.7%). The median follow-up duration was 39 months. Most AIs were non-malignant (92%) and non-functioning (72%). Bilateral lesions were present in 9.6% of patients. Among non-malignant AIs, 27% were functioning, with higher rates of hypertension and osteoporosis, larger tumour size and greater tumour density. Adrenalectomy was more commonly performed in the functioning group, mainly for MACS and pheochromocytoma. In contrast, 94% of benign non-functioning AIs were managed conservatively, with no cases of malignant transformation and only one case developing hormonal activity over a median follow-up of 30 months. Among the 20 malignant AIs, 12 were primary adrenal carcinomas. Malignant AIs were associated with larger size, overt Cushing’s syndrome, higher Hounsfield units, lower contrast washout and increased mortality. MACS was identified in 12.7% of the cohort. It was associated with bilateral lesions, larger tumour size, and higher prevalence of diabetes, dyslipidaemia, obesity and osteoporosis. On multivariate analysis, only bilaterality and osteoporosis remained significant predictors of MACS. Conclusion. This study reinforces that most benign non-functioning AIs carry minimal risk of progression, supporting less intensive follow-up in stable cases. Bilaterality and osteoporosis were identified as independent predictors of MACS, emphasizing the importance of targeted hormonal and bone health monitoring in these patients.
Copyright (c) 2026 Vanusha Devaraja, Subashini Rajoo, Vijaya Mala Valayatham, Foo Siew Hui http://creativecommons.org/licenses/by-nc/4.0
Evaluating the Two-Step TSH Screening Protocol for Congenital Hypothyroidism:
Objectives. This study aimed to determine the prevalence of congenital hypothyroidism (CH) among newborns in Ninh Binh Province, Vietnam, and to evaluate whether adding a second thyroid-stimulating hormone (TSH) screening reduces false positives and improves diagnostic accuracy compared with the traditional single-step screening commonly practiced in Vietnam. Methodology. A retrospective cohort study was conducted on 11,306 newborns screened between January 2019 and December 2020. TSH levels were measured from dried blood spot samples, with a threshold of >9 mU/L indicating high risk. High-risk cases underwent a second screening, followed by confirmation with serum TSH and free thyroxine. Screening performance (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) and risk factors for CH were analyzed. Results. The prevalence of high-risk CH was 2.40% (271/11,306 newborns), with four confirmed cases (incidence: 1:2,826). The two-step screening program achieved a sensitivity of 75.00%, with one false-negative case later detected clinically. Specificity improved from 97.64% in the first screening to 99.81% in the second, while PPV increased more than tenfold (1.11% → 11.54%). Low birth weight infants (≤2,500 g) had a significantly higher CH risk (OR: 10.04, 95% CI: 1.053–95.820, p = 0.004). Conclusions. This first provincial evaluation of two-step CH screening in Vietnam demonstrated that repeat testing significantly reduced false positives and improved diagnostic accuracy without compromising sensitivity. The findings highlight the value of implementing a two-step strategy to optimize newborn screening, reduce unnecessary referrals and save resources in developing countries.
Copyright (c) 2026 Nguyen Hoang Viet, Tran Khanh Hoa, Nguyen Bich Ngan, Bu Thi Bao, Nguyen Anh Ngoc, Van-Thao Ta http://creativecommons.org/licenses/by-nc/4.0
This April 2026 issue of the Journal of the ASEAN Federation of Endocrine Societies arrives at a moment of major transitions and subtle changes within the journal. After 15 years under the able leadership of Editor-in-Chief, Dr. Elizabeth Paz-Pacheco, the baton has been passed to yours truly. Building on this solid foundation, the journal forges onward with its commitment to serve as the "endocrine window between the ASEAN region and the world," by continuing to publish current and relevant research from the region and beyond. One of the changes that is being implemented is the expansion to three issues from the usual two as a result of the high volume of submissions to the journal reflecting the growing interest in and confidence of authors in this regional publication. For this, the journal leadership is grateful to the authors, our JAFES editorial team and the AFES leadership for their support.
Copyright (c) 2026 Cecilia Jimeno http://creativecommons.org/licenses/by-nc/4.0
Letter to the Editor on the article, 'Perioperative Complications Associated with Routine Preoperative Glucocorticoid Use Among Patients Undergoing Pituitary Surgery with Normal Preoperative HPA Axis: A Retrospective Cohort Study'
This letter addresses the recent study by Magnaye et al., which investigated the impact of routine preoperative glucocorticoid administration in patients with a normal hypothalamic-pituitary-adrenal (HPA) axis undergoing pituitary surgery. The authors are commended for their valuable contribution to understanding steroid-related perioperative outcomes. However, we highlight the need for further clarification regarding the wide range of steroid regimens reported and the absence of detailed information on timing, indications, and factors influencing steroid administration. Additionally, differentiating between transient and permanent postoperative diabetes insipidus could provide deeper insight into the observed higher incidence among steroid-treated patients. Addressing these aspects, along with establishing standardized steroid protocols, could enhance the specificity and clinical applicability of the study’s findings.
Copyright (c) 2026 Eisha Fatimah, Sarosh Usman, Muhammad Aqib Farooq Khan http://creativecommons.org/licenses/by-nc/4.0
Papillary Mucinous Neoplasm of the Pancreas Presenting as Worsening Hyperglycemia in a 72-Year-Old Patient with Type 2 Diabetes
*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:2bed871a-e9a3-4711-b75b-fcd61fdc8893-4" data-testid="conversation-turn-10" data-scroll-anchor="false" data-turn="assistant"> Pancreatic cysts are common findings encountered and increasingly detected through cross-sectional imaging. Intraductal papillary mucinous neoplasm (IPMN) is the most common pancreatic cystic neoplasms and may be macroscopic precursor of pancreatic ductal adenocarcinoma. 1 New-onset diabetes or worsening glycemic control may serve as clinical clues to underlying pancreatic neoplasia.2 We present an interesting case of worsening glycemic control in a patient with long-standing type 2 diabetes (T2D) as the first manifestation of IPMN with high-grade dysplasia.
Copyright (c) 2026 Yotsapon Thewjitcharoen, Nopparath Tongpoo, Veekij Veerasomboonsin, Soontaree Nakasatien, Thep Himathongkam http://creativecommons.org/licenses/by-nc/4.0
*]:pointer-events-auto [content-visibility:auto] supports-[content-visibility:auto]:[contain-intrinsic-size:auto_100lvh] R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:f96edd58-2af4-4846-9eb1-5ad260bc19a8-15" data-testid="conversation-turn-32" data-scroll-anchor="false" data-turn="assistant"> Lingual thyroid is the most common form of thyroid ectopia, resulting from failure of normal caudal migration of the thyroid anlage during embryogenesis.1 Diagnosis relies on cross-sectional imaging to define anatomy and radionuclide scintigraphy as the gold standard to verify functional thyroid tissue and exclude normally located gland.2 The images depict the clinical, radiological, and scintigraphic findings of a 27-year-old woman with ectopic lingual thyroid. Clinical photograph showed a smooth, reddish, round mass at the tongue base (Figure 1). Contrast-enhanced CT in sagittal and axial views demonstrated an enhancing lesion at the posterior tongue with the absence of orthotopic thyroid tissue in the pretracheal area (Figure 2). Tc-99m pertechnetate scintigraphy showed focal tracer uptake in the lingual region (Figure 3), confirming the diagnosis of ectopic thyroid tissue.
Copyright (c) 2026 Rizqi Rifani, Dicky Levenus Tahapary http://creativecommons.org/licenses/by-nc/4.0
The Lingering Battle of Persistent Hypoaldosteronism Following Adrenalectomy for Primary Aldosteronism:
Persistent hypoaldosteronism post-adrenalectomy for unilateral primary aldosteronism is not uncommon and should be anticipated in patients with risk factors for development of such condition. Most cases of hypoaldosteronism post-adrenalectomy are transient. However, persistent hypoaldosteronism may occur as a result of delayed recovery of contralateral zona glomerulosa suppression, requiring mineralocorticoid replacement for the prevention or treatment of life-threatening hyperkalemia.
Copyright (c) 2026 Jie En Tan, Nor Shaffinaz Yusoff Azmi Merican, Shartiyah Ismail, Noor Rafhati Adyani Abdullah http://creativecommons.org/licenses/by-nc/4.0
A Rare Paediatric Adrenocortical Carcinoma with Aggressive Clinical Course
Adrenocortical carcinomas are among the rarest and most aggressive paediatric endocrine neoplasms. We report a case of a functional adrenocortical carcinoma in a 6-year and 7-month-old female who initially presented with hypertensive encephalopathy, later progressing to overt Cushing syndrome with refractory hypertension. Given the presence of distant metastases, the patient was commenced on neoadjuvant chemotherapy and mitotane. Genetic testing for TP53 to evaluate Li-Fraumeni syndrome was declined. Despite initial response to the treatment, the disease remained refractory, and the patient succumbed after seven months of therapy.
Copyright (c) 2026 Kah Yin Lim, Pian Pian Tee http://creativecommons.org/licenses/by-nc/4.0
Background. Multiple endocrine neoplasia type 1 (MEN1) is a hereditary condition with an autosomal dominant inheritance, with a predisposition to both endocrine and non-endocrine tumours. MEN1-related tumours can appear as early as the age of five, with disease penetrance increasing with age. Offspring of a MEN1 parent shows a 50% probability of inheriting the MEN1-related gene mutation. A MEN1 diagnosis in a parent can lead to significant anxiety for both the diagnosed parent and their undiagnosed at-risk children. There is limited consensus specific for managing offspring of individuals diagnosed with MEN1. Objectives. This review aims to evaluate the existing literature on the outcomes of MEN1 syndrome in the offspring of affected patients, to identify gaps in current protocols and to suggest possible improvements. Methodology. A literature review was conducted to examine the outcomes and characteristics of the offspring of individuals diagnosed with MEN1. Results. Predictive testing and screening for organ involvement in MEN1 aid early diagnosis and timely interventions. DNA testing is recommended for children within the first decade of life, and screening for organ involvement should ideally begin at age 5 years for all MEN1 mutation carriers. Manifestations of MEN1 in younger children are different from those of affected adults. Conclusions. Standardised, internationally-accepted guidelines that provide specific recommendations for screening, diagnosis and treatment of offspring of adults diagnosed with MEN1 is a timely need. Furthermore, the absence of national and international data pooling across regions remains a serious limitation, impeding the ability to draw conclusions from larger, more representative patient populations.
Copyright (c) 2026 Dimuthu Tharanga Muthukuda, Kushalee Poornima Jayawickreme, Gayathri Wijeweera, Ashley Grossman http://creativecommons.org/licenses/by-nc/4.0
High Remnant Cholesterol Increased the Risk of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) or Non-Alcoholic Fatty Liver Disease (NAFLD)
*]:pointer-events-auto [content-visibility:auto] supports-[content-visibility:auto]:[contain-intrinsic-size:auto_100lvh] R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:f96edd58-2af4-4846-9eb1-5ad260bc19a8-8" data-testid="conversation-turn-18" data-scroll-anchor="false" data-turn="assistant"> Background. MAFLD is currently acknowledged as the most common chronic liver disease and is strongly associated with obesity, metabolic dysregulation and diabetes. MAFLD is defined by the accumulation of lipids within the liver due to impaired lipid metabolism. Objective. The objective of this study is to assess the association between increased remnant cholesterol levels and the likelihood of developing MAFLD or NAFLD. Methodology. A systematic review and meta-analysis were performed in accordance with PRISMA recommendations. Databases such as the Cochrane Library and PubMed were queried for relevant material through March 21, 2025, using specific keywords related to remnant cholesterol and fatty liver disorders. The inclusion criteria concentrated on research investigating the influence of remnant cholesterol on the incidence of NAFLD/MAFLD. Data extraction and quality evaluation were conducted utilizing the JBI Critical Appraisal Checklist for Cohort Studies and ROBINS-I instruments. Results. Six studies were eventually included in our systematic review, including cross-sectional studies with a total of 45,821participants. The meta-analysis, conducted with Review Manager version 5.4, demonstrated a significant association between elevated remnant cholesterol levels and an increased risk of NAFLD/MAFLD, yielding a relative risk (RR) of 3.18 (95% CI 1.89-5.37; p <0.00001; I2 = 99%). This indicates a robust link between remnant cholesterol and the prevalence of various hepatic disorders. Conclusion. Remnant cholesterol is associated with MAFLD or NAFLD. Increased remnant cholesterol is a risk factor for MAFLD or NAFLD.
Copyright (c) 2026 Taufik Biya, Himawan Sanusi, Andi Makbul Aman http://creativecommons.org/licenses/by-nc/4.0
Liver Enzyme Biomarkers Before or in Early Pregnancy as Predictors for Gestational Diabetes Mellitus
Background. 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. Methodology. 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. Results. 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. Conclusion. 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.
Copyright (c) 2026 Samuel Pratama, Rizka Dwi Aulia, Indi Jazilah, Brigitta Cindy Lauren http://creativecommons.org/licenses/by-nc/4.0
Addressing Unmet Needs in the Management of Diabetes in Asia and Enhancing Diabetes Care Through the Use of Digital Technology:
*]:pointer-events-auto scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" tabindex="-1" data-turn-id="request-WEB:8e812dba-7742-485c-ace9-78b66eb836ee-1" data-testid="conversation-turn-4" data-scroll-anchor="true" data-turn="assistant"> Background. Asia faces a growing diabetes burden compounded by low awareness, limited access, affordability concerns, and heterogeneous care practices. These challenges hinder consistent management across the region. Methodology. An expert panel representing India, Japan, South Korea, the Philippines, Singapore, Australia, and Austria reviewed regional barriers, compared national practices, and proposed feasible strategies for improvement. Results. Key gaps included healthcare access, affordability, limited workforce capacity, poor adherence to guidelines, cultural influences, and underuse of digital tools. Experts examined region-specific approaches, highlighting effective models from Singapore, India, Japan, the Philippines, China, Malaysia, Indonesia, Thailand, and South Korea. Discussion. Synthesized insights yielded policy-oriented and practical recommendations, focusing on insurance expansion, digital and AI-enabled care, workforce strengthening, and community-based programs to enhance diabetes care delivery. Conclusion. Tailored, region-specific, and technology-enabled strategies addressing systemic and economic barriers are vital to strengthen diabetes management across Asia.
Copyright (c) 2026 Daphne SL Gardner, Julia K. Mader, Sanjay Kalra, Irene Kopp, Banshi Saboo, Kazuhiro Sugimoto, Michael Villa, Shailendra Bajpai http://creativecommons.org/licenses/by-nc/4.0