Type 2 diabetes mellitus (T2DM) is strongly associated with cardiovascular disease (CVD). This study aimed to examine the association between diabetes duration and major cardiovascular outcomes, including coronary artery disease (CAD), congestive heart failure (CHF), cerebrovascular accident (CVA), and peripheral arterial disease (PAD), among Thai adults with T2DM using nationwide data from 2018. This cross-sectional study utilized data from the "Assessment in Quality of Care among Patients Receiving a Diagnosis of Type 2 Diabetes and Hypertension Visiting the Ministry of Public Health and Bangkok Metropolitan Administration Hospital" database in Thailand. Adult patients aged ≥ 18 years with T2DM were included, and those without documented diabetes duration were excluded. Diabetes duration was stratified into four groups: <5 years, 5-9 years, 10-14 years, and ≥ 15 years. Multivariable logistic regression analyses were performed to evaluate the association between diabetes duration and cardiovascular outcomes after adjusting for age, sex, body mass index, hypertension, dyslipidemia, smoking status, alcohol consumption, and glycemic control. Among 34,131 participants, the overall prevalence of CAD, CHF, CVA, and PAD was 1.9%, 0.8%, 1.5%, and 0.3%, respectively. Compared with a diabetes duration of < 5 years, a duration of ≥ 15 years was associated with higher odds of CAD (adjusted odds ratio [AOR] 1.80, 95% confidence interval [CI] 1.38-2.34), CHF (AOR 2.34, 95% CI 1.60-3.44), and PAD (AOR 6.47, 95% CI 3.09-13.58), whereas no significant association was observed for CVA. These findings suggest a cross-sectional association between longer diabetes duration and a higher prevalence of certain cardiovascular diseases, particularly CAD, CHF, and PAD, among adults with T2DM. Longitudinal studies are needed to confirm causality and to guide clinical interventions targeting cardiovascular risk in this population.

Background: This study aimed to determine the prevalence of osteosarcopenia and evaluate the diagnostic performance of phase angle, derived from bioelectrical impedance analysis, in identifying osteosarcopenia among older adults with type 2 diabetes mellitus. Method: A cross-sectional study was conducted with 147 participants aged 60 years or older, recruited from an outpatient clinic in Thailand between during 2024. Osteosarcopenia was diagnosed when criteria for both sarcopenia, defined by low skeletal muscle mass and either reduced handgrip strength or impaired physical performance, and osteoporosis, defined by a T-score of −2.5 or lower on dual-energy X-ray absorptiometry, were met. Participant characteristics, physical function, laboratory values, and body composition data were collected. Univariable Firth’s penalized logistic regression identified low body mass index and a lower phase angle as independent predictors of osteosarcopenia. Results: The overall prevalence of osteosarcopenia was 7.5 percent. Receiver operating characteristic curve analysis showed strong diagnostic performance of phase angle, with an area under the curve of 0.865. A cutoff value of less than 4.0 degrees achieved 100% sensitivity, 62.5% specificity, and 100% negative predictive value. These findings suggest that phase angle may be a practical, noninvasive screening tool for identifying older adults with type 2 diabetes mellitus who are at risk for osteosarcopenia. Its application in routine clinical settings could enable earlier intervention and reduce long-term complications associated with musculoskeletal decline in this vulnerable population.

Sarcopenia is common among older adults with type 2 diabetes mellitus (T2DM) and is associated with increased risks of functional decline and adverse health outcomes. Phase angle (PhA), derived from bioelectrical impedance analysis, has emerged as a potential marker of muscle health. This cross-sectional study aimed to evaluate the predictive value of PhA for detecting sarcopenia in older adults with T2DM and to determine sex-specific cutoff values for sarcopenia screening. A total of 390 patients aged ≥60 yr with T2DM were included. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Lower PhA values were significantly associated with sarcopenia, and PhA showed good discriminatory performance for detecting sarcopenia. Sex-specific cutoff values improved the diagnostic accuracy of PhA for sarcopenia screening. These findings suggest that PhA may serve as a practical and noninvasive tool for identifying sarcopenia in older adults with T2DM. Further longitudinal studies are warranted to confirm its prognostic value.

Background Obesity is a rising global health issue, especially among women, with important effects on reproductive health. This problem is becoming more urgent in Asia, reflecting worldwide trends in increasing rates. Despite expanding evidence, integrated guidance remains limited. This narrative clinical review synthesizes current evidence to provide practical clinical recommendations. Methods This was a narrative clinical review informed by expert opinion and developed by the Thai Interest Group in Obesity and Female Reproductive Health through an interdisciplinary collaborative process. The approach included a comprehensive literature review across various databases to gather high-quality scientific evidence, clinical guidelines, and epidemiological data on the connection between obesity and female reproductive health. Results The review summarizes current evidence on how obesity affects key reproductive conditions, including polycystic ovary syndrome (PCOS), infertility, and menopause. Obesity is strongly associated with PCOS, contributing to hormonal imbalances, insulin resistance, and metabolic dysfunction. It also impacts fertility by disrupting ovarian function and increasing the risk of pregnancy complications. Furthermore, menopausal women with obesity face higher risks of cardiovascular disease, metabolic disorders, and severe menopausal symptoms due to increased visceral adiposity and hormonal changes. Evidence supports the role of weight management, including lifestyle changes and pharmacological interventions, in improving reproductive outcomes. Weight reduction has been shown to improve ovulation, menstrual regularity, and fertility in women with PCOS and obesity. Anti-obesity drugs have proven effective for weight loss and enhancing reproductive health. Conclusion Obesity has significant negative effects on female reproductive health from adolescence to menopause but these issues can be reversed with effective weight management. With the increasing rate of obesity in Asia, healthcare professionals must prioritize weight management strategies to mitigate its harmful impact on women's reproductive health.

Background:Sarcopenic obesity is an age-related condition characterized by a simultaneous decline in muscle mass and function and by increased adipose tissue. Its prevalence, particularly in Asian populations with type 2 diabetes mellitus (T2DM), remains unclear. This study aimed to determine the prevalence and risk factors associated with sarcopenic obesity in Thai people with T2DM. Methods:This cross-sectional, observational study included 329 Thai adults with established type 2 diabetes mellitus (T2DM), consecutively recruited from an outpatient clinic. Participants underwent standardized assessments, including bioelectrical impedance analysis, physical performance testing, and laboratory evaluations. Obesity was defined based on percentage body fat derived from bioelectrical impedance analysis, rather than body mass index. The study aimed to determine the prevalence of sarcopenic obesity and to identify associated risk factors. Univariate and multivariate logistic regression analyses were performed to identify independent predictors after adjustment for potential confounders. Results:The prevalence of sarcopenic obesity in T2DM was 16.4%, with rates of 15.4% in males and 17.5% in females. Sarcopenia was present in 23.7% of participants, including 7.3% with sarcopenia alone (without obesity). Obesity without sarcopenia was reported in 61.1% (95% CI: 55.7, 66.2). Factors significantly associated with a higher risk of sarcopenic obesity included older age (adjusted OR 1.08, 95% CI 1.01-1.15, P < 0.001) and smaller calf circumference (aOR 1.35, 95% CI 1.11-1.67, P < 0.001). Protective factor included greater handgrip strength (aOR 0.93, 95% CI 0.87-0.99, P < 0.001). Conclusions:The study found a high prevalence of sarcopenic obesity among Thai people with T2DM. Older age and smaller calf circumference were identified as key risk factors. Higher muscle strength was associated with a lower risk of developing sarcopenic obesity.

Type 2 Diabetes Mellitus (T2DM) is closely linked with sarcopenia. The lack of validated, easy, and effective sarcopenia screening tools for people with T2DM may result in underdiagnosis, delayed interventions, and worsening outcomes. This study evaluated and compared the diagnostic accuracy of various sarcopenia screening tools in T2DM outpatients. A cross-sectional study was conducted on 329 people with T2DM at Phramongkutklao Hospital, Thailand, between December 2023 and November 2024. This study compared eight sarcopenia screening tools. The Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria served as the reference standard. Sensitivity, Specificity, and diagnostic accuracy were evaluated using receiver operating characteristic (ROC) curve analysis. The optimal cutoffs were identified with the Youden index. The prevalence of sarcopenia was 23.7

Obesity is an emerging public health issue and a significant risk factor for type 2 diabetes mellitus (T2DM). The growing prevalence of obesity in T2DM patients worsens disease outcomes, elevates medical expenses, and increases the risk of cardiovascular complications. Recognizing the trends and related factors of obesity in T2DM patients is essential for guiding specific interventions and public health strategies. This study aims to analyze the trends in obesity prevalence among T2DM patients in Thailand from 2014 to 2018 and to identify significant demographic, clinical, and lifestyle factors linked to obesity. This sequential cross-sectional study utilized secondary data from the Thailand DM/HT database in 2014 and 2018. It did not include individuals under 18 or those with incomplete data. Descriptive statistics were used to analyze demographic characteristics and obesity prevalence, while multivariable logistic regression was employed to identify factors independently associated with obesity. Additionally, linear regression analysis assessed the relationships between BMI and continuous variables, including age, systolic blood pressure (SBP), and HbA1c levels. A total of 32,196 patients in 2014 and 38,119 in 2018 were included. The prevalence of obesity among T2DM patients rose from 49.9

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. The triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio has emerged as a potential marker for CVD risk. However, its predictive value for high 10-year predicted Cardiovascular (CV) risk remains unclear; This study evaluates the predictive value of the TG/HDL-C ratio for 10-year cardiovascular risk using the Framingham Heart Study (FHS) risk prediction model in individuals with Type 2 Diabetes Mellitus (T2DM). A cross-sectional study was conducted on 61,004 adults from 2014,2015, and 2018 aged 30–74 years with T2DM, without a history of CVD. The FHS model was used to estimate 10-year predicted CV risk, and high CVD risk was defined as ≥ 20

PURPOSE OF REVIEW:As the prevalence of diabetes mellitus (DM) increases due to urbanization, aging populations, and lifestyle changes, it is crucial to understand the mechanisms, diagnosis, and treatment of diabetes-related bone disorders. This review highlights recent advancements in the field and explores their implications for clinical practice and research. RECENT FINDINGS:Recent studies have elucidated the complex interplay between diabetes and bone health, emphasizing the roles of advanced glycation end-products (AGEs), inflammation, oxidative stress, senescence, and molecular signaling pathways such as Wnt, mammalian target of rapamycin (mTOR), and exosome-mediated mechanisms. Key findings highlight the significance of bone marrow adipose tissue (BMAT) in bone metabolism and the impact of sarcopenia on fracture risk. Novel diagnostic tools, including miRNA biomarkers and emerging therapeutic strategies like exosome-based therapies and glycogen synthase kinase 3 beta (GSK3β) inhibitors, offer promising opportunities for improving bone health in diabetic patients. SUMMARY:The findings underscore the need for integrated strategies for managing diabetes-related bone complications. Clinicians should prioritize early screening, lifestyle interventions, and personalized pharmacological treatments to mitigate fracture risk and improve bone health in diabetic patients. Future research should focus on optimizing diagnostic tools and developing targeted therapies to address the unique challenges of bone disorders related to diabetes.

Abstract Disclosure: P. Samakkarnthai: None. C. kookanok: None. M. Poochanasri: None. W. Kaewput: None. R. Rangsin: None. N. Sathavarodom: None. A. Boonyavarakul: None. Background: There are numerous health complications linked to obesity, especially in Diabetic Patients. However, the prevalence of obesity in people with diabetes is still unclear. Methodology: In 2014 and 2018, sequential cross-sectional investigations were carried out on patients receiving medical treatment at hospitals enrolled in Thailand's Universal Coverage Scheme. These hospitals are located throughout the country and provide care at various levels. Our study seeks to ascertain the trends and factors associated with obesity in individuals with diabetes in Thailand. Results: A total of 33,288 and 38,568 electronic medical records for individuals in 2014 and 2018, respectively, were included in the study. Obesity was 50.3% in 2014 and 50.7% in 2018. The mean BMI in 2014 was 25.5; in 2018, it increased to 25.7. The paired samples t-test indicated a statistically significant change between the two periods (95% CI: -0.20 to -0.05, p < 0.001). Obesity is associated with various factors, including receiving care in an urban standard/advanced hospital (OR 1.51, 95% CI: 1.13-2.01), an indoor occupation (OR 1.40, CI: 1.16-1.40), ex-smoker (OR 1.51, 95% CI: 1.06-2.13), gout (OR 1.20, 95% CI: 1.01-1.43) and hypertension (OR 1.40, 95% CI: 1.18-1.67)Conclusions: Our research highlights the rise in obesity rates and BMI changes among diabetic patients between 2014 and 2018. These findings reinforce the strong connection between obesity and various health issues. Notably, urban standard/advanced hospitals, indoor occupation, and ex-smokers tend to have higher obesity rates. The association between obesity and conditions like gout and hypertension underscores the need for effective weight management strategies incorporated with treating comorbidity in diabetic patients. Presentation: 6/3/2024

Background Type 2 Diabetes mellitus (T2DM) significantly impacts cardiovascular disease (CVD). This study investigates the role of diabetes duration in determining CVDs, including coronary artery disease (CAD), congestive heart failure (CHF), cerebrovascular disease (CVA), and peripheral arterial disease (PAD) in Asian individuals with T2DM, based on 2018 data from Thai adults. Methods Thai adult patients with T2DM were recruited, and the duration of diabetes was stratified. Logistic regression analysis was used to identify CVD risk factors, and the final model was performed using multivariable logistic regression analysis. Result The study comprised 34,131 participants. The final model revealed adjusted odds ratios for CAD (AOR 1.80, 95% CI: 1.38–2.34), CHF (AOR 1.81, 95% CI: 1.22–2.67), and PAD (AOR 6.47, 95% CI: 3.09–13.58) with diabetes durations exceeding 15 years. However, the association between diabetes duration and CVA showed less consistency. Conclusion The duration of DM is a significant determinant of cardiovascular risk, especially for conditions including CAD, CHF, and PAD, but not CVA.

T2DM (Type 2 Diabetes Mellitus) patients with vertebral fractures have a higher mortality rate than non-DM (nondiabetic patients). However, the prevalence of vertebral fractures in the Asian diabetic population is not well established. Moreover, despite an apparent increase in fracture risk in patients with diabetes, Asian countries have provided contradictory data demonstrating that bone mineral density (BMD) varies significantly in T2DM patients. The aim of this study was to examine and compare the prevalence of vertebral fractures and osteoporosis, as well as BMD and the FRAX score, between individuals with and without T2DM and assess the association of these factors with vertebral fractures. Postmenopausal Thai women attending diabetic and health check-up clinics were recruited. BMD at the lumbar spine, total hip, and femoral neck was measured via dual-energy X-ray absorptiometry. A morphometric vertebral fracture (VF) was defined by a lateral thoracolumbar (T-L) X-ray radiograph. The Fracture Risk Assessment Tool (FRAX) was used to calculate the 10-year probabilities of hip and major osteoporotic fracture (MOF), which were calculated on the basis of the Thai FRAX model. A total of 435 participants were recruited, including 145 postmenopausal women with T2DM and 290 non-DM individuals. T2DM patients had a significantly greater BMI (p = 0.006) and BMD at the femoral neck (p = 0.024) and total hip (p = 0.017), but there was no significant difference in the FRAX score, including the 10-year probability of hip fracture or MOF, either with or without BMD, between individuals with and without T2DM. The prevalence of osteoporosis in non-DM women was significantly higher at the femoral neck (OR = 0.56, 95% CI: 0.34 to 0.93, p = 0.029) but comparable at the lumbar spine. Individuals with T2DM had a significantly higher rate of vertebral fractures, particularly those involving two or more levels, than those without T2DM. Diabetes was significantly associated with \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:\ge\:$$\end{document}2 VF (OR = 3.83, 95% CI: 1.77 to 8.28, p = 0.001), and the association remained unchanged after controlling for other clinical factors (adjusted OR = 3.72, 95% CI 1.70-8.15; p = 0.001). Our study demonstrated a greater prevalence of multiple (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\:\ge\:$$\end{document} two levels) VFs in women with T2DM than in non-DM controls.

Introduction: The prevalence of Type 2 Diabetes Mellitus (T2DM) is expected to rise, increasing the risk of cardiovascular disease. This study explores the relationship between high-density lipoprotein cholesterol (HDL) and glycemic control in T2DM patients, measured by hemoglobin A1c (HbA1c). While HDL is known to confer cardiovascular benefits, its impact on glycemic control remains unclear. Methods: This cross-sectional study analyzed 30,195 Thai adults with T2DM data from the 2018 Thailand DM/HT database. Well-controlled HbA1c was defined as less than 53 mmol/mol (7 %). The study utilized multivariable linear, piecewise linear, and logistic regression analyses to investigate the relationship between HDL levels and glycemic control. Results: The impact of HDL on HbA1c levels was nonlinear, showing a U-shaped relationship among the study participants with an HDL inflection point of 59 mg/dl. In females, a U-shaped relationship was also observed at the same inflection point, where increased HDL above this level was associated with a rise in HbA1c (Adjusted β = 0.205, P < 0.001). In contrast, a linear model better explained the consistent negative relationship between HDL and HbA1c in males (Adjusted β = –0.076, P < 0.001). Furthermore, in the poorly controlled HbA1c group, a significant U-shaped pattern was observed with an inflection point at 59 mg/dl. Conclusion: This study found a nonlinear, gender-specific relationship between HDL and HbA1c in T2DM patients. Males with higher HDL are more likely to achieve glycemic control, while a U-shaped relationship is observed in females. Further research is needed to understand the differing correlation between well-controlled and poorly controlled groups.

ABSTRACTIn addition to reducing fracture risk, zoledronate has been found in some studies to decrease mortality in humans and extend lifespan and healthspan in animals. Because senescent cells accumulate with aging and contribute to multiple co-morbidities, the non-skeletal actions of zoledronate could be due to senolytic (killing of senescent cells) or senomorphic (inhibition of the secretion of the senescence-associated secretory phenotype [SASP]) actions. To test this, we first performedin vitrosenescence assays using human lung fibroblasts and DNA repair-deficient mouse embryonic fibroblasts, which demonstrated that zoledronate killed senescent cells with minimal effects on non-senescent cells. Next, in aged mice treated with zoledronate or vehicle for 8 weeks, zoledronate significantly reduced circulating SASP factors, including CCL7, IL-1β, TNFRSF1A, and TGFβ1 and improved grip strength. Analysis of publicly available RNAseq data from CD115+ (CSF1R/c-fms+) pre-osteoclastic cells isolated from mice treated with zoledronate demonstrated a significant downregulation of senescence/SASP genes (SenMayo). To establish that these cells are potential senolytic/senomorphic targets of zoledronate, we used single cell proteomic analysis (cytometry by time of flight [CyTOF]) and demonstrated that zoledronate significantly reduced the number of pre-osteoclastic (CD115+/CD3e-/Ly6G-/CD45R-) cells and decreased protein levels of p16, p21, and SASP markers in these cells without affecting other immune cell populations. Collectively, our findings demonstrate that zoledronate has senolytic effectsin vitroand modulates senescence/SASP biomarkersin vivo. These data point to the need for additional studies testing zoledronate and/or other bisphosphonate derivatives for senotherapeutic efficacy.

In addition to reducing fracture risk, zoledronic acid has been found in some studies to decrease mortality in humans and extend lifespan and healthspan in animals. Because senescent cells accumulate with aging and contribute to multiple co-morbidities, the non-skeletal actions of zoledronic acid could be due to senolytic (killing of senescent cells) or senomorphic (inhibition of the secretion of the senescence-associated secretory phenotype [SASP]) actions. To test this, we first performed in vitro senescence assays using human lung fibroblasts and DNA repair-deficient mouse embryonic fibroblasts, which demonstrated that zoledronic acid killed senescent cells with minimal effects on non-senescent cells. Next, in aged mice treated with zoledronic acid or vehicle for 8 weeks, zoledronic acid significantly reduced circulating SASP factors, including CCL7, IL-1β, TNFRSF1A, and TGFβ1 and improved grip strength. Analysis of publicly available RNAseq data from CD115+ (CSF1R/c-fms+) pre-osteoclastic cells isolated from mice treated with zoledronic acid demonstrated a significant downregulation of senescence/SASP genes (SenMayo). To establish that these cells are potential senolytic/senomorphic targets of zoledronic acid, we used single cell proteomic analysis (cytometry by time of flight [CyTOF]) and demonstrated that zoledronic acid significantly reduced the number of pre-osteoclastic (CD115+/CD3e-/Ly6G-/CD45R-) cells and decreased protein levels of p16, p21, and SASP markers in these cells without affecting other immune cell populations. Collectively, our findings demonstrate that zoledronic acid has senolytic effects in vitro and modulates senescence/SASP biomarkers in vivo. These data point to the need for additional studies testing zoledronic acid and/or other bisphosphonate derivatives for senotherapeutic efficacy.

Fracture risk is increased in patients with type 2 diabetes mellitus (T2DM). In addition, these patients sustain fractures despite having higher levels of areal bone mineral density, as measured by dual-energy X-ray absorptiometry, than individuals without T2DM. Thus, additional factors such as alterations in bone quality could have important roles in mediating skeletal fragility in patients with T2DM. Although the pathogenesis of increased fracture risk in T2DM is multifactorial, impairments in bone material properties and increases in cortical porosity have emerged as two key skeletal abnormalities that contribute to skeletal fragility in patients with T2DM. In addition, indices of bone formation are uniformly reduced in patients with T2DM, with evidence from mouse studies published over the past few years linking this abnormality to accelerated skeletal ageing, specifically cellular senescence. In this Review, we highlight the latest advances in our understanding of the mechanisms of skeletal fragility in patients with T2DM and suggest potential novel therapeutic approaches to address this problem. This Review outlines the pathogenesis of skeletal fragility in patients with type 2 diabetes mellitus, and discusses potential therapeutic approaches to the management of increased fracture risk in these patients. The evidence that skeletal fragility should now be included in the list of well-recognized diabetic complications is also summarized.