Chii-Min HwuProf. Taiwan

Chii-Min HwuProf.
Professor Chii-Min Hwu is currently Professor in the Department of Medicine at National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, a position held since 2022. In the same year, Professor Hwu was appointed Chief of the Section of Endocrinology and Metabolism in the Department of Medicine at Taipei Veterans General Hospital, where he has served as an attending physician in the same specialty since 2009. Professor Hwu received postgraduate research training as a Research Scholar in the Division of Clinical Epidemiology and Preventive Medicine at the University of California, Los Angeles (UCLA) from 2001 to 2002. Prior to specializing in endocrinology and metabolism, he served as an attending physician in the Section of General Medicine at Taipei Veterans General Hospital from 1997 to 2009. In addition to his clinical and academic appointments, Professor Hwu has demonstrated sustained leadership in the field of diabetes and metabolic research. He has served on the Editorial Board of the Journal of the Chinese Medical Association since 2024 and has been Associate Editor of the World Journal of Diabetes since 2021. Since 2019, he has been a member of the Board of Directors of the Chinese Taipei Diabetes Association. Professor Hwu has authored and co-authored more than 270 SCI-indexed and non-SCI academic publications, reflecting his extensive contributions to endocrinology, metabolism, and diabetes research. His early academic excellence was recognized with the MSD Award for Young Investigator from the Diabetes Association of the Republic of China in 2000 and the Choh Hao Li Memorial Fund for Hormone Research Award from the American Bureau for Medical Advancement in China in 2001. His work continues to advance clinical care, translational research, and academic leadership in endocrinology and metabolic medicine.

20 MARCH

Time Session
13:50
15:20
[Symposium] Diabetes Mellitus (2)
Gestational Diabetes in Asian Countries
Chii-Min HwuTaiwan Moderator
Hung-Yuan LiTaiwan Moderator Diagnosis and Evaluation of ObesityObesity is now widely recognized as a chronic, heterogeneous disease rather than a simple consequence of excess body weight. Contemporary perspectives emphasize that obesity-related health risk arises not only from the quantity of adipose tissue, but also from its distribution and functional status. In recent years, major international organizations—including the The Lancet Commission on Obesity, the American Association of Clinical Endocrinology (AACE), the European Association for the Study of Obesity (EASO), the Japan Society for the Study of Obesity (JASSO), and the American Diabetes Association (ADA)—have proposed evolving frameworks for obesity diagnosis that move beyond reliance on body mass index (BMI) alone. This session will review current concepts in the diagnosis and evaluation of obesity, integrating anthropometric measures, adiposity distribution, obesity-related complications, and functional consequences of excess fat. While BMI remains a practical and widely used screening tool, its limitations at the individual level are increasingly recognized. Complementary measures such as waist circumference and waist-to-height ratio provide important additional information, particularly for assessing central adiposity and cardiometabolic risk in Asian populations. A central theme of this lecture is the concept of obesity-related complications and diseases (ORCD), which can be broadly categorized into two interrelated entities. Fat mass disease refers to conditions driven predominantly by excessive fat mass and its mechanical or quantitative burden, whereas sick fat disease reflects adipose tissue dysfunction characterized by abnormal endocrine, inflammatory, and metabolic signaling. Both entities contribute to ORCD, either independently or in combination, and together account for the heterogeneous clinical manifestations of obesity. According to the definitions proposed by the Lancet Commission on Obesity, obesity can be conceptualized along a continuum from preclinical obesity to clinical obesity. Preclinical obesity is characterized by excess adiposity without established ORCD and corresponds conceptually to AACE stage 1, representing a key opportunity for primary prevention. In contrast, clinical obesity is defined by the presence of ORCD and aligns with AACE stage 2 and stage 3, in which clinical management focuses on secondary prevention, risk reduction, and complication management. This integration of Lancet Commission concepts with AACE staging provides a disease-oriented framework for risk stratification and therapeutic decision-making. Comprehensive obesity evaluation must also address psychological, behavioral, and socio-cultural factors. Mental health conditions such as binge-eating disorder, depression, and anxiety may both contribute to and result from obesity, forming bidirectional relationships that influence disease trajectory. In addition, weight stigma, health literacy, and environmental and cultural contexts significantly affect treatment acceptance, adherence, and long-term outcomes, and should be incorporated into routine clinical assessment. In conclusion, this session will propose a pragmatic, stepwise approach to obesity diagnosis and evaluation that integrates ORCD phenotyping with AACE stage 1–3 classification and the conceptual framework of the Lancet Commission. This approach is intended not only to inform clinical decision-making, but also to serve as the foundation for the forthcoming obesity-related clinical practice guidelines of the Diabetes Association of the Republic of China, bridging global concepts with local implementation.
  • Is Continuous Glucose Monitoring Ready for Screening and Monitoring of Gestational Diabetes in Asian Populations?
    Ling-Jun LiSingapore Speaker Is Continuous Glucose Monitoring Ready for Screening and Monitoring of Gestational Diabetes in Asian Populations?Gestational diabetes mellitus (GDM) is highly prevalent across Asia, where genetic susceptibility, rapid urbanization, and uneven access to antenatal care contribute to rising maternal and neonatal complications. Current screening and monitoring rely on oral glucose tolerance testing (OGTT) and self-monitored blood glucose (SMBG), but both have limitations, including sparse capture of glycaemic variability, patient burden, and missed postprandial excursions. Continuous glucose monitoring (CGM) provides near real-time glucose profiles that can support more responsive management, and emerging studies suggest that early-pregnancy CGM metrics may help predict GDM diagnosed later in pregnancy. However, the evidence remains heterogeneous, with variation in diagnostic criteria, population characteristics, device type, adherence, and background care pathways. Given Asia’s high and growing GDM burden, region-specific evidence is needed to inform guideline and policy development. This talk will synthesize findings from Asian studies, with a particular focus on work from Singapore, and discuss what is required for CGM to move from promising tool to routine practice in GDM screening and management in Asian populations.
  • The Impact of Underweight in Young Women on GDM and the Next Generation
    Hirohito SoneJapan Speaker The Impact of Underweight in Young Women on GDM and the Next Generation In Japan and some neighboring East Asian countries, it is somewhat surprising given their socio-economic level that underweight, rather than obesity, is a significant health issue for young women. According to the National Health and Nutrition Survey in Japan, the proportion of underweight women in their 20s (BMI < 18.5) has remained above 20% for decades. Despite this, many young women overestimate their own body size, with numerous individuals attempting to lose weight even though they are actually within the normal range. This reveals a discrepancy between perceived and actual body size, alongside the existence of a desire to be thin. The ideal thin body shape is influenced by social trends and traditional values that posit thinness as more attractive, as well as the influence of mass media and social media. Entertainers and fashion models are often seen as being too thin. The health effects of being underweight in young women are known to include increased osteoporosis and mortality, but adverse effects on pregnancy and pregnancy outcomes have also been observed. Underweight women have a higher risk of gestational diabetes mellitus (GDM), a higher rate of low birth weight, and a lower birth rate compared to women of normal weight. Indeed, in Japan, the rate of low birth weight infants has been increasing in parallel with the proportion of thin women. Recent findings from DOHaD (Developmental Origins of Health and Disease) and fetal programming research have revealed that low birth weight infants face a higher future risk of developing metabolic diseases such as diabetes and hypertension. Consequently, maternal underweight before pregnancy and weight-control behaviors after pregnancy likely have adverse health effects on future generations. Based on this background, Japan has revised the standards for appropriate weight gain during pregnancy, and discussions are currently underway regarding GDM pregnant women. Furthermore, as part of preconception care, education on the importance of maintaining a healthy weight and body image is being promoted, starting from junior high and high school. The trend toward underweight among young Japanese women, even during pregnancy, is a major national health issue, as it affects not only the health of the women themselves but also the next generation. However, its causes are complex, and multifaceted measures involving society as a whole are required. These countermeasures are also expected to be useful for prevention of same issues in other East Asian countries as well in the future.
  • Gestational Diabetes and Perinatal Outcomes in A Large Multi-Ethnic Australian Population
    I-Lynn LeeAustralia Speaker Gestational Diabetes and Perinatal Outcomes in A Large Multi-Ethnic Australian PopulationGestational diabetes (GDM) is highly prevalent in a multi-ethnic Australian population in West Melbourne with high representation from South Asian, South East/Central Asian, Middle Eastern, African and Pacific communities. These ethnicities carry a disproportionate higher risk of GDM with earlier diagnosis in pregnancy. Australia adoped the IADPSG screening method in 2015 for which GDM prevalence rose sharply there after accompanied by rising rates of maternal obesity and changes in migration patterns from high risk ethnicities. GDM education is delivered in a group setting and sometimes individualised for culturally and liguistically diverse women. Dietary advice is also delivered in a culturally specific and sensitive manner. Treatment initiation differed with South Asian women requiring pharmacotherapy earlier and insulin use was highest among Middle Eastern women. A smartphone and internet based interactive glucose management system for managing women with GDM is being trialled with an aim to improve efficiency of care delivery. Despite rising GDM prevalence and maternal obesity, the large for gestational age remains unchanged over time. Maternal BMI remains a dominant risk factor for LGA. Induction of labour rates also rose significantly over the last 10 years. It is important to develop multilingual education resources and delivering culturally adapted nutritional counselling is essential to optimising care for women with GDM living in Melbourne's rapidly growing cultural diverse metropolitan communities.
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22 MARCH

Time Session
14:00
15:30
[DAROC Symposium 5] Medication
Insulin Therapy Across the Spectrum of Diabetes
Chia-Hung LinTaiwan Moderator The New Era of Insulin Therapy: Ultra-Long Acting, Smart Delivery, and BeyondInsulin therapy is entering a transformative era driven by innovations in pharmacology, delivery systems, and data integration, fundamentally reshaping diabetes management. The development of ultra-long-acting basal insulin analogues has markedly improved glycemic stability by providing flatter, more predictable pharmacokinetic and pharmacodynamic profiles with extended duration of action. These agents reduce glycemic variability, lower the risk of nocturnal and overall hypoglycemia, and allow greater dosing flexibility, thereby improving treatment adherence and quality of life for people with diabetes. Beyond molecular advances, smart insulin delivery technologies are redefining how insulin is administered and titrated. Continuous subcutaneous insulin infusion (CSII) systems integrated with continuous glucose monitoring (CGM) have evolved into automated insulin delivery (AID) or hybrid closed-loop systems that dynamically adjust basal insulin and deliver correction boluses based on real-time glucose data. These systems consistently demonstrate superior time-in-range, reduced hypoglycemia, and decreased patient burden compared with conventional multiple daily injections or sensor-augmented pump therapy. Increasingly, algorithm refinement, interoperability, and personalization are enabling broader clinical applicability across age groups and diabetes phenotypes. Collectively, these advances signal a paradigm shift from reactive glucose control toward proactive, personalized, and technology-enabled insulin therapy. The integration of ultra-long-acting insulins, smart delivery systems, and digital innovations promises to further improve glycemic outcomes, safety, and patient-centered care in the management of diabetes.
Chii-Min HwuTaiwan Moderator
  • Insulin as Lifeline: Optimizing Regimens in Type 1 Diabetes
    Yi-Ching TungTaiwan Speaker Insulin as Lifeline: Optimizing Regimens in Type 1 Diabetes
  • When, What, and How: Practical Approaches to Insulin Use in Type 2 Diabetes
    Ju-Ying JiangTaiwan Speaker When, What, and How: Practical Approaches to Insulin Use in Type 2 DiabetesPractical insulin use in type 2 diabetes (T2D) requires clear decisions on when to start therapy, what regimen to choose, and how to titrate effectively. Insulin is indicated when lifestyle measures and non-insulin medications fail to achieve glycemic goals, especially when Hba1c is ≥10%, fasting glucose is >250–300 mg/dL, or when patients show symptomatic hyperglycemia or catabolic features. Insulin is also required during acute illness, surgery, pregnancy, or corticosteroid use. Basal insulin remains the preferred first step due to its simplicity and lower hypoglycemia risk. Long-acting insulin analogues such as Glargine or Degludec are commonly initiated at 10 units or 0.1–0.2 U/kg/day with stepwise titration. When additional blood sugar control is needed, options include adding a GLP-1 receptor agonist, moving to basal-plus or basal-bolus regimens, or using premixed insulin for patients with fixed routines. Importantly, once-weekly basal insulin formulations—such as insulin icodec—are emerging as a future option, offering flatter pharmacokinetics and the potential to improve adherence by reducing injection frequency. These agents may simplify initiation and long-term management for patients hesitant about daily injections. Overall, individualized regimen selection, structured titration, and patient-centered education remain essential for safe and effective insulin therapy.
  • The New Era of Insulin Therapy: Ultra-Long Acting, Smart Delivery, and Beyond
    Chia-Hung LinTaiwan Speaker The New Era of Insulin Therapy: Ultra-Long Acting, Smart Delivery, and BeyondInsulin therapy is entering a transformative era driven by innovations in pharmacology, delivery systems, and data integration, fundamentally reshaping diabetes management. The development of ultra-long-acting basal insulin analogues has markedly improved glycemic stability by providing flatter, more predictable pharmacokinetic and pharmacodynamic profiles with extended duration of action. These agents reduce glycemic variability, lower the risk of nocturnal and overall hypoglycemia, and allow greater dosing flexibility, thereby improving treatment adherence and quality of life for people with diabetes. Beyond molecular advances, smart insulin delivery technologies are redefining how insulin is administered and titrated. Continuous subcutaneous insulin infusion (CSII) systems integrated with continuous glucose monitoring (CGM) have evolved into automated insulin delivery (AID) or hybrid closed-loop systems that dynamically adjust basal insulin and deliver correction boluses based on real-time glucose data. These systems consistently demonstrate superior time-in-range, reduced hypoglycemia, and decreased patient burden compared with conventional multiple daily injections or sensor-augmented pump therapy. Increasingly, algorithm refinement, interoperability, and personalization are enabling broader clinical applicability across age groups and diabetes phenotypes. Collectively, these advances signal a paradigm shift from reactive glucose control toward proactive, personalized, and technology-enabled insulin therapy. The integration of ultra-long-acting insulins, smart delivery systems, and digital innovations promises to further improve glycemic outcomes, safety, and patient-centered care in the management of diabetes.
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