Noriko Satoh-Asahara Japan

• Advancing Toward a Cure for Diabetes: Insights from iPSC-Derived Islet Cell Transplantation Trial
  Daisuke YabeJapan Speaker Advancing toward a Cure for Diabetes: Insights from iPSC-Derived Islet Cell Transplantation TrialType 1 diabetes is characterized by absolute insulin deficiency and marked glycemic variability, creating a constant challenge for individuals who must maintain strict glycemic control to prevent complications and severe hypoglycemia. To address these persistent unmet medical needs, transplantation of pancreatic islet–like cells derived from embryonic stem (ES) or induced pluripotent stem (iPSC) cells has emerged as a promising therapeutic strategy. Encouraging advances have recently been reported from the United States and China. Notably, a world-first autologous transplantation of patient-specific iPSC-derived islet-like cells in China achieved insulin independence with near-normal glycemic control. Despite its promise, concerns remain regarding long-term safety, durability, and broad applicability, underscoring the need for further rigorous clinical evaluation. This lecture will provide an overview of current progress and ongoing challenges in β-cell replacement therapy aimed at curing type 1 diabetes. In addition, I will introduce the study design of our clinical trial at Kyoto University Hospital evaluating allogeneic transplantation of iPSC-derived islet cell sheets (OZTx-410). Through these insights, we aim to highlight both the steady steps already taken and the horizon of possibilities ahead in the pursuit of a functional cure for diabetes.Incretin-Based Therapeutics: Bridging Theory and Practice, and Exploring New HorizonsThe landscape of type 2 diabetes management has been transformed by the advent of incretin-based therapies, including dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. In Japan—where more than 70% of individuals with diabetes are aged 65 years or older and commonly present with a non-obese phenotype and reduced insulin secretory capacity—DPP-4 inhibitors continue to serve as a fundamental treatment option, offering effective glycemic control with minimal risk of hypoglycemia. In contrast, among younger adults with obesity, GLP-1 receptor agonists have emerged as essential agents that not only improve glycemic control but also promote weight reduction and confer cardiovascular and renal benefits. A major advance in 2023 was the approval of tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist that engages both receptors. Tirzepatide has demonstrated robust glucose-lowering and weight-reducing effects in both clinical trials and real-world practice in Japan, further expanding therapeutic opportunities across the region. However, incretin-based therapies are not without challenges: gastrointestinal adverse events remain common, and potential associations with pancreatic and biliary diseases continue to require caution. In older adults, concerns regarding their impact on frailty and sarcopenia demand careful clinical judgment. Furthermore, inappropriate discontinuation of insulin therapy after initiating incretin treatment has occasionally resulted in severe clinical consequences, highlighting the critical need for decision-making that extends beyond the evidence from controlled trials. In response to these issues, the Japan Diabetes Society (JDS) Committee for the Safe Use of Medications released the Recommendations for the Safe Use of Incretin-Related Agents, Second Edition in 2024. Disseminating these recommendations across East Asia and the broader Asia–Oceania region will be essential to ensure the safe and effective application of incretin-based therapies in diverse clinical settings. In this plenary lecture, I will explore strategies to optimize type 2 diabetes management in Asia by harnessing the therapeutic potential of incretin-based agents while proactively mitigating associated risks. Together, we aim to build a future in which innovation, safety, and patient-centered care advance hand in hand.
• AI-Driven Precision Drug Therapy: Tailoring Personalized Treatment for Type 2 Diabetes
  Kang-Chih FanTaiwan Speaker AI-Driven Precision Drug Therapy: Tailoring Personalized Treatment for Type 2 Diabetes Type 2 diabetes (T2D) is a highly heterogeneous syndrome where "one-size-fits-all" algorithms often fail to address individual pathophysiological variations. While recent guidelines prioritize cardiorenal protection, the choice between second-line agents—particularly SGLT2 inhibitors versus GLP-1 receptor agonists—remains largely empirical. This "trial-and-error" paradigm frequently results in therapeutic inertia and suboptimal glycemic durability. Artificial Intelligence (AI) and machine learning (ML) offer a paradigm shift from population-based guidelines to precision diabetology. By integrating high-dimensional data from electronic health records (EHR), continuous glucose monitoring (CGM), and routinely available clinical features, AI models can now quantify heterogeneous treatment effects (HTE) at the individual level. In this presentation, I will discuss: 1. Phenotypic Stratification: Moving beyond classic classification to identify data-driven clusters (e.g., severe insulin-resistant vs. age-related clusters) that dictate distinct disease trajectories. 2. Predictive Pharmacotherapy: Reviewing recent evidence where ML algorithms predict individual glycemic response, cardiorenal outcomes, and weight loss outcomes for specific drug classes. We will highlight how AI-driven decision support can optimize the selection between SGLT2 inhibitors and GLP-1 receptor agonists, maximizing efficacy while minimizing adverse events. 3. Real-World Implementation: Discussing the potential of leveraging large-scale longitudinal datasets, such as Taiwan’s National Health Insurance Research Database (NHIRD), to build robust, population-specific prediction models and facilitate the clinical adoption of explainable AI (XAI). Bridging the gap between data science and clinical practice, this session aims to demonstrate how AI can empower clinicians to prescribe the right drug for the right patient at the right time, fundamentally transforming T2D management.Anti-Obesity Medications: Clinical Use Obesity is a chronic, relapsing neurobehavioral disease requiring long-term management. Recent guidelines have shifted the treatment goal from BMI-centric weight loss to a "health-centered" approach, focusing on the remission of weight-related complications. With the advent of nutrient-stimulated hormone-based therapies, we have entered an era where pharmacotherapy can achieve double-digit weight loss comparable to bariatric surgery, offering systemic organ protection. In this session, we will navigate the clinical use of anti-obesity medications (AOMs) through three key dimensions based on the latest evidence: 1. Efficacy and Organ Protection: We will review the landmark trials establishing GLP-1 and dual GIP/GLP-1 receptor agonists as the cornerstone of treatment. Highlights include Semaglutide (STEP, SELECT, ESSENCE) and Tirzepatide (SURMOUNT, SUMMIT, SURMOUNT-OSA), demonstrating not only 15–20% weight loss but also breakthrough benefits in cardiovascular outcomes (MACE), heart failure with preserved ejection fraction (HFpEF), metabolic dysfunction-associated steatohepatitis (MASH), and obstructive sleep apnea (OSA). 2. Comorbidity-Directed Strategy: A practical framework for drug selection will be proposed, distinguishing between "Fat Mass Disease" (e.g., OSA, osteoarthritis), which benefits primarily from mechanical weight reduction, and "Sick Fat Disease" (e.g., T2D, CVD, MASH), which requires correction of adipose dysfunction. We will discuss how to prioritize agents like Semaglutide and Tirzepatide for high-risk profiles, while utilizing Naltrexone/Bupropion for emotional eating or Orlistat for patients requiring non-systemic options. 3. Asian Perspectives & Practical Management: We will present data confirming that Asian populations, who are highly sensitive to metabolic risks, achieve weight loss efficacy comparable to Western populations with Semaglutide and Tirzepatide (STEP-7, SURMOUNT-CN/J). Finally, we will address practical strategies for dose titration to mitigate GI adverse events and emphasize the necessity of chronic treatment to prevent weight regain. This presentation aims to equip clinicians with a precision medicine approach, ensuring the right AOM is prescribed to maximize both weight reduction and holistic health outcomes.
• Closing the Type 2 Diabetes Gap in Cardiovascular and Renal Disease
  Jenny GuntonAustralia Speaker Closing the Type 2 Diabetes Gap in Cardiovascular and Renal DiseasePeople with type 2 diabetes die, on average, 6-7 years earlier. This is mostly due to excess cardiovascular events. This presentation will discuss options for lowering cardiovascular and renal risk in people with type 2 diabetes.Managing Hyperglycaemia in Patients Receiving Immune Checkpoint InhibitorsIt is estimated that >20% of people treated with Immune Checkpoint Inhibitors (ICI) for their cancer will experience new or worsening hyperglycaemia. This presentation will discuss the differential diagnoses for the cause of hyperglycaemia in people treated with ICI and treatment strategies

• Preoperative Molecular Testing for Thyroid Nodules
  Guodong FuCanada Speaker Preoperative Molecular Testing for Thyroid NodulesTitle: Preoperative Quantitative Molecular Testing for a Definitive Cancer Diagnosis among Patients with Thyroid Nodules Objective: Molecular testing is increasingly used in the assessment of thyroid nodules. Tumors harboring the same genomic variant may not behave the same because a gene variant is not expressed equally in tumor cells among patients. This study is to delineate interpatient variabilities in genomic variants in thyroid tumors and assess their diagnostic significance in definitive thyroid cancer diagnosis. Methods: Interpatient differences in BRAF V600E, TERT promoter, and RAS variants (ie, NRAS, HRAS, and KRAS) were analyzed in residual thyroid fine-needle aspiration (FNA) biopsies and compared with surgical histopathologic diagnoses. Malignancy rates, sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated. Results: This retrospective study enrolled 620 patients (470 [75.8%] female; mean [SD] age, 50.7 [15.9] years), including 438 surgically resected thyroid tumors and 249 thyroid nodule FNA biopsies. Of 438 tumors, 178 (40.6%) and 58 (13.2%) carcinomas were detected with interpatient variabilities of BRAF V600E and TERT promoter variants (C228T and C250T), with variant allele fraction (VAF) levels ranging from 0.03% to 48.56% and 0.13% to 54.74%, respectively. Furthermore, 89 (20.3%) were identified with the presence of RAS variants, including 51 (11.6%) with NRAS, 29 (6.6%) with HRAS, and 9 (2.1%) with KRAS, with VAF levels ranging from 0.15% to 51.53%. VAF assays of 249 residual FNA specimens identified 50 specimens (20.1%) with BRAF V600E, 25 FNAs (10.0%) with TERT promoter variants, and 36 specimens (14.5%) with RAS variants with interpatient variabilities (including 23 FNAs [9.2%] with NRAS, 10 FNAs [4.0%] with HRAS, and 3 FNAs [1.2%] with KRAS). Interpatient differences in the 5 gene variants (NRAS, HRAS, KRAS, BRAF, and TERT) were detected in 54 of 126 indeterminate FNAs (42.9%) and 18 of 76 ND FNAs (23.7%). Compared with the 5 gene variants detected in the matched surgical specimens, VAF assays on residual FNA biopsies exhibited a high agreement (κ = 0.80; P < .001) and demonstrated a sensitivity of 87.1% (95% CI, 69.2%-95.8%), specificity of 92.5% (95% CI, 78.5%-98.0%), PPV of 90.0% (95% CI, 72.3%-97.4%), and NPV of 90.2% (95% CI, 75.9%-96.8%). Conclusions: This diagnostic study delineated that quantitative discrimination of interpatient variabilities in genomic variants could facilitate cytology examinations in preoperative precision malignancy diagnosis among patients with thyroid nodules.
• Harnessing Molecular Diagnostics in Cytologically-Indeterminate Thyroid Nodules
  Samantha Peiling YangSingapore Speaker Harnessing Molecular Diagnostics in Cytologically-Indeterminate Thyroid NodulesCytologically indeterminate thyroid nodules (Bethesda III–IV) remain a common diagnostic challenge, as cytology alone cannot reliably distinguish benign from malignant disease. Molecular diagnostic tests have emerged as important adjuncts to refine malignancy risk and guide clinical management. This presentation reviews the molecular landscape of thyroid cancer relevant to indeterminate nodules, including key somatic alterations such as BRAF, RAS, and gene fusions (e.g., RET, NTRK, ALK), and discusses the performance of contemporary molecular diagnostic tests. Data from North America and emerging real-world experience in Singapore will be highlighted. The clinical utility of molecular diagnostics in reducing unnecessary diagnostic surgery and informing the extent of surgical management will be discussed, together with current guidance from the ATA 2025 guidelines on integrating molecular results with clinical, radiologic, and cytopathologic findings. Re-Differentiation Therapy in RAI-Refractory Thyroid CancerRadioactive iodine (RAI) therapy remains a cornerstone in the management of differentiated thyroid cancer. However, a subset of patients develop RAI-refractory disease due to loss of iodine-handling gene expression, including the sodium–iodide symporter (NIS). This loss is frequently associated with activation of the MAPK signalling pathway driven by oncogenic alterations such as BRAF and RAS mutations. While systemic therapy with multi-targeted or mutation-specific tyrosine kinase inhibitors (TKIs) can control disease progression, these treatments are generally not curative and do not consistently restore RAI sensitivity. Re-differentiation therapy has emerged as a promising strategy to restore iodine uptake by targeting MAPK signalling and re-inducing thyroid-specific gene expression. This presentation will review the biological rationale for re-differentiation therapy and summarize key clinical studies evaluating BRAF and MEK inhibition in patients with RAI-refractory thyroid cancer. Emerging approaches, optimal treatment duration, and potential predictors of response will also be discussed, highlighting the potential of re-differentiation therapy to restore the therapeutic benefit of RAI in selected patients.
• Preoperative Diagnosis of Thyroid Cancer
  Kiyomi HoriuchiJapan Speaker Preoperative Diagnosis of Thyroid Cancer

• Obesity: What Clinicians Should Know
  Alice KongHong Kong, China Speaker Obesity: What Clinicians Should KnowRapid changes in technology, human behavior and lifestyle over the past few decades have resulted in a dramatic increase in the prevalence of obesity worldwide. Besides social stigmata and psychological consequences, obesity is associated with escalated risks of type 2 diabetes, coined the term "Diabesity", hypertension, dyslipidemia, sleep apnoea, metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), polycystic ovarian syndrome, cancers, cardiovascular diseases and increased mortality. Body mass index (BMI) is a commonly adopted tool to identify people with obesity. Clinicians should note that the cutoff points of BMI for clinical actions are different between people with obesity from the East and the West, as well as the limitations of BMI in diagnosing obesity. Recently, the Lancet Diabetes and Endocrinology Commission proposed a new definition of obesity which differentiates excess adiposity with obesity-related illness (clinical obesity) from those without obesity-related diseases (pre-clinical obesity). Also, people with clinical obesity have many unmet needs requiring personalized treatment regimens, intensive counselling and emotional support. The 5 A's framework including Ask, Assess, Advise, Agree and Assist, provide a patient-centred approach to promote lasting behavioral change in obesity management. In addition to lifestyle modifications and behavioral changes, pharmacological agents for weight reduction, bariatric and metabolic surgeries are therapeutic options requiring careful selections for the appropriate patients with adequate counselling of the risks and benefits. Through case sharing approach, the use of weight reducing drugs and surgical strategies for people with preclinical and clinical obesity will be discussed in this session. Acknowledgement: The work described in this lecture was partially supported by funding from Health and Medical Research Fund (HMRF), Food and Health Bureau, Hong Kong SAR, China (Reference number:21223391), Matching Grant from Research Grants Council (reference number: 8601556), and Area of Excellence Scheme, Research Grants Council, Hong Kong SAR, China (Reference number: AoE/M-401/24-R). Obesity Management: What's New?Obesity is a global health hazard with rising prevalence in most parts of the world. Weight reduction by lifestyle modification remains the cornerstone in the prevention and treatment of obesity. However, weight management by lifestyle therapy alone is difficult to sustain in many obese individuals with rebound of body weight being observed as a common phenomenon. Given the invasiveness of bariatric and metabolic surgeries which are not accepted by many people with obesity, the use of pharmacological agents in weight management is increasingly popular. In 2025, the Lancet Diabetes and Endocrinology Commission proposed a new definition of obesity which differentiates excess adiposity with obesity-related illness (clinical obesity) from those without obesity-related diseases (pre-clinical obesity). Among the various obesity complications, diabetes is well recognized to be closely related to obesity, with the term 'Diabesity' coined to show the strong link between these two important modifiable risk factors of cardiovascular disease and premature death. In recent decades, many new generation anti-diabetic drugs are developed and found to have weight reducing properties. Looking ahead, more new drugs are in the pipeline of clinical trials, and the results may eventually change the landscape of obesity management. Acknowledgement: The work described in this lecture was partially supported by funding from Health and Medical Research Fund (HMRF), Food and Health Bureau, Hong Kong SAR, China (Reference number:21223391), Matching Grant from Research Grants Council (reference number: 8601556), and Area of Excellence Scheme, Research Grants Council, Hong Kong SAR, China (Reference number: AoE/M-401/24-R).

• Novel Biomarkers and Treatment Strategies in Thyroid Eye Disease
  Chia-Hung LinTaiwan Speaker Novel Biomarkers and Treatment Strategies in Thyroid Eye DiseaseThyroid Eye Disease (TED), also known as Graves' orbitopathy, remains a complex autoimmune condition that significantly impacts patients' vision and quality of life. Traditionally, management has relied mainly on non-specific anti-inflammatory therapies. However, as our understanding of its molecular pathogenesis evolves, there is an increasing clinical demand for more precise diagnostic tools and targeted therapeutic interventions. This presentation provides a comprehensive overview of the current landscape and future directions in the management of TED. We will discuss the emergence of novel serum and molecular biomarkers that offer potential for earlier diagnosis and more accurate prediction of disease progression. These biomarkers may bridge the gap between clinical observation and underlying immunological activity. Furthermore, we will explore the shift in treatment paradigms, moving from conventional systemic corticosteroids toward innovative biological agents. By targeting specific signaling pathways involved in orbital inflammation and remodeling, these new strategies aim to provide more effective and durable clinical outcomes. The integration of novel biomarkers and advanced treatment modalities is reshaping the management of TED. Moving toward a more individualized approach will allow clinicians to optimize therapeutic timing and selection, ultimately improving the long-term prognosis for patients with this challenging condition.
• Management of Thyroid Eye Disease: Insights from Clinical Experience and MRI Findings in Japan
  Ichiro YamauchiJapan Speaker Management of Thyroid Eye Disease: Insights from Clinical Experience and MRI Findings in JapanIn Japan, disease activity of thyroid eye disease (TED) is commonly assessed using magnetic resonance imaging (MRI) in addition to clinical activity score (CAS). Recently, we proposed an MRI-guided categorization of active moderate-to-severe TED based on our retrospective data. We retrospectively analyzed TED cases treated at our department between 2015 and 2022 with a combination of daily steroid pulse therapy and orbital radiation. Among 44 cases with diplopia, we classified 17 cases as severe (diplopia in the primary position) and 27 as non-severe (diplopia only in non-primary positions). The severe group was older (median 67 years) and had lower TSAb titers (median 324%) compared to the non-severe group (median 56 years, median TSAb 2443%). CAS was similar between the groups. MRI revealed that proptosis was more pronounced in the non-severe group (median 21.4 mm) than in the severe group (median 17.5 mm), whereas the difference in proptosis between eyes was larger in the severe group (median 2.0 mm) than in the non-severe group (median 0.9 mm). High signal intensity of orbital fat on STIR sequence was more frequently observed in the non-severe group (68.2%) than in the severe group (20.0%). These findings suggest that TED patients with severe diplopia are characterized by older age, lower TSAb titers, and greater asymmetry in proptosis. In contrast, CAS and STIR signal intensity of orbital fat were not indicative of severity. In this context, severe diplopia often develops despite low CAS and mild proptosis. We also present our clinical experience with teprotumumab, an anti–IGF-1 receptor antibody. Since its launch in Japan in 2024, we have treated several patients with severe TED, the majority of whom showed remarkable improvement in clinical features. However, adverse effects such as hearing impairment and hyperglycemia were occasionally observed, highlighting the importance of appropriate management. In conclusion, MRI-guided evaluation provides valuable insights for individualized management of TED. Evidence regarding the efficacy of teprotumumab remains limited in the subtype characterized by severe diplopia, which often presents with low CAS and mild proptosis. The MRI-guided approach may help clinicians select optimal therapeutic strategies, including steroid pulse therapy, teprotumumab, and other emerging agents.
• Update on Thyroid Eye Disease Management - Asia Pacific Perspectives
  Kelvin ChongHong Kong, China Speaker Update on Thyroid Eye Disease Management - Asia Pacific PerspectivesExisting guidelines/recommendations/consensus on the management of thyroid eye disease (TED)/Graves' orbitopathy (GO) pose significant difficulties when applied in the Asia Pacific region. The presenter will share his experiences and challenges in setting up the first thyroid eye clinic in Hong Kong, developing an image-guided medical and surgical decompression, while looking into the future of intelligence-based management of TED/GO.

• 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.

• Advancement in AI Applications to Thyroid Nodule Detection and Evaluation
  Argon ChenTaiwan Speaker Advancement in AI Applications to Thyroid Nodule Detection and EvaluationDiagnosing thyroid cancer remains challenging due to overlapping imaging features between benign and malignant nodules, inherent limitations of current diagnostic tools, and substantial interobserver variability among clinicians. Although ultrasound is the first-line modality for thyroid nodule evaluation, interpretations of the same images often differ across physicians. The Thyroid Imaging Reporting and Data System (TI-RADS) was developed to standardize malignancy risk assessment; however, considerable variability in its application persists in clinical practice. Artificial intelligence (AI) is increasingly transforming thyroid cancer diagnosis by enhancing accuracy, efficiency, and consistency in clinical decision-making. By leveraging machine learning and deep learning techniques, AI-based systems offer new opportunities to reduce subjectivity in ultrasound interpretation and support more personalized patient care. This talk will focus on recent advances in AI-assisted ultrasonographic detection and characterization of thyroid nodules. Specifically, we will present evidence from Multi-Reader Multi-Case (MRMC) performance studies demonstrating how AI can improve diagnostic accuracy and inter-reader consistency across different TI-RADS guidelines. We will also compare the consistency of nodule interpretation across ultrasound systems between AI algorithms and human readers. Finally, a live demonstration of the AI software will illustrate its performance using ultrasound images from a wide spectrum of benign and malignant thyroid nodules.
• Electronic Dashboard-Based Remote Glycemic Management Program Reduces Length of Stay and Readmission Rate among Hospitalized Adults
  Yi-Jing SheenTaiwan Speaker Electronic Dashboard-Based Remote Glycemic Management Program Reduces Length of Stay and Readmission Rate among Hospitalized AdultsBackground: Inpatient dysglycemia is strongly associated with prolonged length of stay (LOS), increased readmission rates, and higher healthcare costs. Traditional consultation-based models are often insufficient for institution-wide glycemic quality improvement. With advances in electronic medical records (EMRs), real-time digital surveillance offers a scalable solution. We implemented a hospital-wide remote glycemic management program to evaluate its impact on glycemic control and clinical outcomes. Methods: Building on our previously published framework, this institution-wide before-and-after study was conducted in a 1,500-bed tertiary medical center using data from 2016 to 2019 (106,528 hospitalized adults; 878,159 glucose measurements). The core intervention utilized an EMR-integrated dashboard to identify hyper-/hypoglycemia in real-time, enabling endocrinologists to provide daily virtual recommendations without formal consultation. Key components included automated risk stratification, real-time alerts, and department-specific performance feedback. Primary outcomes were LOS and 30-day readmission rates. Analyses were performed using Poisson and joinpoint regression with multivariable adjustment. Results: Program implementation resulted in consistent and clinically significant improvements in hospital-wide glycemic metrics. Rapid improvement in treat-to-target rates was observed within 3–6 months of initiating virtual recommendations. Clinical Outcomes: The program was associated with a significant reduction in LOS, independent of age, sex, and admission department. Notably, patients with high glucose variability exhibited the longest LOS, identifying glycemic instability as a key driver of resource utilization. Furthermore, 30-day readmission rates decreased significantly, particularly among patients achieving stable euglycemia. Operational Efficiency & Pandemic Resilience: As glycemic quality improved, the time required for daily virtual recommendations decreased from ~2 hours to <1 hour. The program significantly reduced the need for formal consultations. Crucially, this established remote workflow proved vital during the COVID-19 pandemic, minimizing clinician exposure and preserving personal protective equipment (PPE) while maintaining high-quality glycemic care without disruption. Conclusion: Integrating real-time EMR-based surveillance with remote endocrinologist-led intervention significantly improves inpatient glycemic control, translating into measurable reductions in LOS and 30-day readmission rates. This model has demonstrated sustained efficacy extending into the COVID-19 era and beyond, proving that an electronic dashboard-based system is a scalable, resilient, and resource-efficient strategy for modern hospital care.
• A New Era of Managing Thyroid Eye Disease
  Jae Hoon MoonSouth Korea Speaker A New Era of Managing Thyroid Eye Disease: AI-Based Quantitative Monitoring and Precision CareThyroid Eye Disease (TED) is the most common extrathyroidal manifestation of autoimmune thyroid dysfunction, occurring in approximately 30% to 50% of patients with Graves’ disease. While endocrinologists primarily manage thyroid dysfunction, TED can severely impact a patient’s quality of life through vision loss, diplopia, and cosmetic concerns, necessitating active early intervention. Consequently, it is crucial for clinicians to be proficient in basic TED assessments for early diagnosis; however, many endocrinologists remain unfamiliar with these evaluations, which often leads to delayed treatment. To usher in a new era of managing TED, a paradigm shift toward AI-based quantitative monitoring and precision care is explored in this session. Fundamental assessment methods, including the Clinical Activity Score (CAS), exophthalmos, and Margin-Reflex-Distance 1 (MRD1), will be introduced alongside clinical cases where AI-driven solutions provide objective and reproducible data. These cutting-edge tools go beyond simple diagnostic assistance by quantitatively tracking disease progression and treatment response, thereby facilitating highly personalized treatment plans. By integrating these innovative AI solutions, a comprehensive approach to TED management is presented, demonstrating how technology and innovation converge to solve long-standing clinical challenges and improve patient outcomes.

• Update in Primary Aldosteronism
  Mitsuhide NaruseJapan Speaker Update in Primary AldosteronismPrimary aldosteronism (PA) is linked to significantly greater cardiovascular morbidity and mortality than essential hypertension, yet it offers a more favorable prognosis when appropriately treated. Early detection and targeted therapy are therefore essential for achieving optimal long-term outcomes and preserving quality of life. Since the release of the Endocrine Society’s guidelines in 2010, several countries—including Japan—have developed national recommendations (e.g., Endocrine Journal, 2021). This reflects growing awareness and research momentum, with over 3,500 publications in the past decade. In Japan, we have established a national PA registry and conducted multicenter studies under the Japan Primary Aldosteronism Study (JPAS), supported by AMED, resulting in more than 40 publications as Japan-originated evidence. Diagnostic protocols have become increasingly standardized, encompassing initial screening, confirmatory testing, subtype classification via adrenal venous sampling (AVS), and tailored treatment—mineralocorticoid receptor (MR) antagonists for bilateral PA and adrenalectomy for unilateral PA. The integration of PA screening into routine hypertension care, alongside the standardization of diagnostic methods, has led to substantial improvements in clinical practice. However, key challenges remain. These include variability in assay methods (e.g., PRA vs. ARC for renin; CLEIA vs. RIA for aldosterone), which affects diagnostic thresholds; uncertainty regarding optimal cutoffs for screening and confirmatory tests; lack of consensus on AVS protocols (with or without cosyntropin); and ongoing debates over the role of non-invasive imaging and advanced surgical approaches (laparoscopic vs. robot-assisted adrenalectomy). These unresolved issues warrant evaluation through a cost-effectiveness lens. As PA diagnostics become increasingly integrated into hypertension management, a fundamental question emerges: How far should we go in diagnosing PA? This presentation will provide an updated overview of clinical practice and address these critical challenges in PA management.Do We Still Need Confirmatory Testing?

• History of Asia Oceania Congress of Endocrinology
  Takashi AkamizuJapan Speaker History of AOCEThe 1st Asian-Oceanian Congress of Endocrinology (AOCE) was held in Kyoto in 1959, one year prior to the 1st International Congress of Endocrinology (ICE). Subsequently, the AOCE was held every four years until the 16th Congress in Yogyakarta, Indonesia, in 2018. Subsequently, AOCE shifted to a biennial schedule, with the 17th AOCE scheduled for Seoul, South Korea in 2020. However, the 18th AOCE was inevitably held online due to the COVID-19 pandemic. Now is an opportune moment to reflect on AOCE's history and move forward toward future development.

• Lipoprotein(a): What Endocrinologists Need to Know
  Kathryn TanHong Kong, China Speaker Lipoprotein(a): What Endocrinologists Need to KnowLipoprotein(a) [Lp(a)] is a cholesterol-rich LDL-like particle with apolipoprotein(a) covalently linked to apolipoprotein B100 via a disulfide bond. Lp(a) is synthesized within the liver and there is a general inverse correlation between Lp(a) isoform size and plasma Lp(a) concentrations. About 90% of plasma Lp(a) concentration is genetically determined and plasma levels can modestly rise after menopause in women, and in conditions like hypothyroidism, nephrotic syndrome. It has been shown that elevated Lp(a) is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis. Although Lp(a) concentration does vary with ethnicity, relationships between Lp(a) concentration and ASCVD risk remain similar across different ethnic groups. Elevated Lp(a) is considered a cardiovascular risk-enhancing or amplification factor, and recent guidelines and consensus have increasingly recommended universal screening for Lp(a). There are as yet, no approved therapies for elevated Lp(a). Current management focuses on intensifying control of concurrent risk factors, particularly LDL-C, to reduce ASCVD risk. Amongst existing lipid-lowering drugs, only proprotein convertase subtilisin/kexin type 9 inhibitors can lower Lp(a) levels modestly. Emerging RNA-based and small-molecule therapeutics are under development and are showing promising Lp(a)-lowering effects up to 80-90%. Ongoing phase 3 cardiovascular outcomes trials will determine whether effectively lowering Lp(a) can translate to cardiovascular benefit.
• A Novel Therapeutic Concept for Familial LCAT Deficiency: Long-Term Enzyme Replacement Using Genetically Modified Adipocytes
  Masayuki KurodaJapan Speaker A Novel Therapeutic Concept for Familial LCAT Deficiency: Long-Term Enzyme Replacement Using Genetically Modified AdipocytesFamilial lecithin:cholesterol acyltransferase (LCAT) deficiency is a rare autosomal recessive disorder marked by defective HDL maturation, leading to corneal opacity, hemolytic anemia, and progressive renal dysfunction. No disease-modifying treatment has been established to date. Conventional enzyme replacement requires repeated administration with limited durability. Glybera, the first AAV1-based gene therapy for lipoprotein lipase deficiency, was withdrawn after limited clinical use and modest benefit. More broadly, in vivo AAV gene therapies face challenges including immune responses, hepatotoxicity at high vector doses, and considerable inter-patient variability in transgene expression. Our therapeutic approach originated from studies in diabetic mouse models, where adipocytes were explored as platforms for sustained protein delivery. These cells demonstrated endocrine-like properties and long-term protein secretion in vivo. Adipocytes are particularly suited for this purpose due to their longevity, secretory capacity, and low tumorigenic risk. Building on these findings, we established an ex vivo gene and cell therapy platform using genetically modified adipocytes (GMAC), autologous adipocyte-derived cells engineered to express therapeutic proteins. As its first application, we targeted familial LCAT deficiency. These cells were expected to engraft upon subcutaneous implantation, re-differentiate into functional adipocytes, and provide long-lasting and therapeutically relevant LCAT secretion. In a first-in-human clinical trial conducted under Japan’s regulatory framework for regenerative medicine, mature adipocytes were collected from the patient’s subcutaneous fat, converted into proliferative cells via ceiling culture, and transduced to express therapeutic human LCAT, then administered subcutaneously to the patient. Single administration of LCAT-GMAC was well tolerated with no serious adverse events. Sustained increases in serum LCAT activity were observed, accompanied by improvements in lipoprotein profiles and hemolytic anemia. A marked reduction in proteinuria was noted, and renal function remained stable throughout the follow-up period. Remarkably, serum LCAT activity persisted for over eight years after the single administration, the longest durability ever reported for enzyme replacement. This provides the first clinical evidence that ceiling culture-derived, ex vivo modified adipocytes can achieve lasting correction of systemic enzyme deficiencies. LCAT-GMAC therapy thus offers a potentially curative strategy for familial LCAT deficiency and a new paradigm for treating dyslipidemias and other lifelong plasma protein deficiencies.
• Novel and Future Lipid-Lowering Therapy
  Sung Hee ChoiSouth Korea Speaker Novel and Future Lipid-Lowering TherapyIn this lecture, I want to introduce the mechanism of current developing lipid lowering drugs. Small molecular inhibitors such as bempedoic acid, oral forms of newer drugs, Anti-sense oligonucleotide drugs, and siRNA technique based new lipid lowering drugs and its clinical trials. These agents target diverse pathways such as proprotein convertase subtilisin/kexin type 9 (PCSK9), angiopoietin-like protein 3 (ANGPTL3), apolipoprotein C-III (apoC-III), and Lp(a), achieving potent lipid modulation in different mechanistic approach.

• New Concept in Osteoporosis Management
  Daisuke InoueJapan Speaker New Concept in Osteoporosis Management- Japnaese Perspectives Operational definition of osteoporosis by WHO is currently "a BMD value -2.5SD or more below the young adult mean", which has been used worldwide for twenty years. WHO has recently initiated a process to revisit this definition as it is not sensitive enough to identify individuals at high risk of fracture, leading to unsatisfactory treatment of patients. Importantly, a history of fracture, particularly within the past two years (termed imminent fracture risk) has been shown to significantly contribute to the risk of subsequent fractures. Regarding a surrogate for evaluating the clinical efficacy of anti-osteoporotic drugs, a proposal from the FNIH-ASBMR-SABRE project has been submitted to the Food and Drug Administration (FDA). This proposal suggests that treatment-related increases in total hip BMD (TH-BMD) at two years could serve as a surrogate endpoint for fracture risk reduction in clinical trials. This is primarily based on the negative correlation observed between increases in total hip BMD and decreases in the incidence of hip fracture in various clinical trials of anti-osteoporotic drugs demonstrated by a meta-regression analysis. The significant role of BMD as a surrogate, along with availability of bone anabolic agents that can greatly increase BMD for a short period of time, has led to the concept of "Goal-directed treatment" of osteoporosis. Accordingly, "anabolic first" sequential therapy is recommended for individuals at high risk of fractures. In Japan, new Guidelines for Prevention and Treatment of Osteoporosis were issued on August 1, 2025. Recent trends in osteoporosis management, as described above, will be discussed in the context of these Japanese guidelines.
• Bone Fragility in Diabetes
  David LuiHong Kong, China Speaker Bone Fragility in DiabetesDiabetes and osteoporosis are emerging as major public health challenges across Asia, constituting a dual epidemic with significant individual and societal impacts. The Asia-Pacific region accounts for over one-third of the global diabetes population, while osteoporosis-related fractures pose a substantial burden, with one in three women and one in five men over 50 experiencing osteoporotic fractures in their lifetime. Evidence indicates a high fracture burden in Asia, compounded by the increased fragility and poorer outcomes observed in individuals with diabetes. This session will address the urgent need to optimize bone health in the context of the Asian diabetes epidemic. Despite recognition of the increased fracture risk among people with diabetes, the persistent gap representing diabetes-related excess fracture risk appears to remain. A multifaceted approach is needed to address this issue. Key strategies include achieving and maintaining optimal glycaemic control – targeting hyperglycemia, minimizing hypoglycemia, and reducing glycaemic variability – and early intervention for diabetes to reduce occurrence of diabetic complications which in turn are associated with fracture risks. Notably, individuals with type 2 diabetes often fracture at higher bone density T-scores than their non-diabetic counterparts, suggesting that the intervention threshold may need to be modified in this population. Proactive osteoporosis management is essential. Moreover, the high prevalence of coexisting cardiovascular and metabolic comorbidities in individuals with diabetes influences fracture risk, with medication choices potentially impacting skeletal health. Overall, it is hoped that a comprehensive approach integrating glycaemic optimization, proactive osteoporosis management and managing cardiometabolic comorbidities can address this Asian epidemic of diabetes and osteoporosis.
• Metabolic Bone Disorder in Thalassemia
  Wen-Pin YangTaiwan Speaker Metabolic Bone Disorder in ThalassemiaIntroduction: Thalassemia-associated osteoporosis (TAO) is a prevalent and debilitating complication in adult patients with β-thalassemia major (β-TM), despite advancements in transfusion and chelation therapies. Given the complexity of its pathogenesis, TAO presents a unique challenge to endocrinologists, requiring a nuanced understanding of the interplay between ineffective erythropoiesis, iron overload, and the endocrine axis. Pathogenesis & Endocrine Involvement: The aetiology of TAO is multifactorial. Chronic ineffective erythropoiesis leads to bone marrow expansion, causing mechanical disruption of the trabecular microarchitecture. Simultaneously, systemic iron overload (hemosiderosis) exerts direct toxicity on osteoblasts and induces secondary endocrine failures. Clinical evidence demonstrates that BMD in β-TM patients is significantly correlated with multiple endocrine parameters: it is negatively associated with TSH, HbA1c, iPTH, and FGF23 levels, while positively correlating with testosterone and IGF-1. Pituitary and thyroid hemosiderosis are major drivers of impaired peak bone mass accrual and accelerated bone loss. Diagnostic Considerations: While Dual-energy X-ray absorptiometry (DXA) remains the standard for monitoring, its accuracy is often limited by scoliosis, vertebral deformities, and marrow expansion. Complementary tools, such as bone turnover markers (CTX and P1NP) and opportunistic QCT, are essential for a comprehensive skeletal assessment and for identifying patients at high risk for fragility fractures. Therapeutic Strategies: Management requires a multidisciplinary approach beyond optimizing iron chelation and Vitamin D status. Antiresorptive agents, particularly Zoledronate and Denosumab, are effective in increasing BMD and reducing bone pain. However, in severe cases with prevalent fractures, anabolic therapy with Teriparatide has demonstrated superior efficacy, with significant BMD gains in both the lumbar spine and femoral neck. This presentation will emphasize the "sequential therapy" model—initiating with anabolic agents followed by antiresorptives—to maximize and maintain skeletal recovery. Conclusion: TAO requires lifelong vigilance and a tailored treatment plan. Early intervention targeting endocrine deficiencies and the strategic application of sequential pharmacological therapies are vital to preventing fractures and improving the quality of life for this aging population.

• Sex-Specific Approaches in Precision Medicine: Advancing Endocrinology Care
  Shih-Li SuTaiwan Speaker Sex-Specific Approaches in Precision Medicine: Advancing Endocrinology CareSex differences are fundamental determinants of endocrine physiology and disease. Conventional approaches that treat men and women as biologically equivalent overlook variations in hormonal regulation, immune response, organ function, and pharmacologic metabolism. Precision medicine in endocrinology integrates these sex-specific biological and environmental factors to achieve individualized care. Emerging evidence shows that women are more prone to autoimmune thyroid disease, prolactinoma, and osteoporosis, largely due to estrogen-enhanced immune activity and X-chromosome dosage effects. Men, by contrast, experience higher rates of hypogonadism, visceral obesity, and aggressive endocrine tumors, reflecting androgen decline and single X-chromosome vulnerability. Hormonal effects, such as menopause-related bone loss, are often reversible, whereas chromosomal influences—such as those seen in Turner and Klinefelter syndromes—are irreversible and genetically determined. Pharmacokinetic and pharmacodynamic disparities further highlight the need for sex-informed dosing. Women generally have higher CYP3A4 activity and altered drug binding via increased sex hormone–binding globulin. In Asian populations, genetic polymorphisms, including the high prevalence of BRAF^V600E^ mutations in papillary thyroid cancer and variable androgen receptor CAG repeats, demand region-specific precision strategies. Sex-specific precision endocrinology moves beyond a uniform model of care by recognizing biological sex as a key variable in disease risk and treatment response. Incorporating sex-stratified analyses, adjusted diagnostic thresholds, and personalized pharmacotherapy can enhance diagnostic accuracy and therapeutic safety. For Asia, integrating genetic and environmental diversity is essential to advance equitable, individualized endocrine care.
• From the Bedside to the Digital World: Precision Medicine in Endocrinology with Al and ICT
  Miyuki KataiJapan Speaker From the Bedside to the Digital World: Precision Medicine in Endocrinology with Al and ICTPrecision medicine in endocrinology must account for biological variability, life-course hormonal transitions, and sociocultural determinants of health. However, in routine clinical practice, endocrine disorders are often detected only after prolonged symptomatic periods, particularly when symptoms are nonspecific or overlap with normal physiological transitions. Our work originates from bedside clinical challenges. In developing and operating a comprehensive women’s specialty clinic grounded in sex-specific medicine—representing an innovative clinical model in Japan—we evaluated more than 5,000 women. Among patients who presented to our clinic with a prior diagnosis of menopausal disorders, organic diseases were identified in 27%. Thyroid dysfunction accounted for approximately 15% of cases initially attributed to menopausal disorders. These findings suggest that menopausal diagnoses may contribute to delayed recognition of underlying diseases. Among conditions masked by such symptoms, endocrine disorders were frequently identified, likely because many endocrine diseases require additional targeted laboratory testing for definitive diagnosis. Within endocrine disorders, thyroid dysfunction was particularly prevalent in women. To address this unmet need, we developed the Women’s AI Symptom Evaluator (WaiSE), a digital platform designed to visualize multidimensional symptom patterns using AI-assisted structured questionnaires. WaiSE was developed to support detection of a broad spectrum of underrecognized conditions in women, including endocrine disorders such as thyroid disease. Importantly, these digital tools help women recognize and articulate complex autonomic symptom patterns commonly experienced during menopausal transitions, thereby enabling clinicians to better interpret symptom presentations and facilitating earlier detection of endocrine disorders. The platform is supported by a gender-specific clinical database derived from over 5,000 patients and more than 60,000 consultations, enabling symptom–diagnosis correlation modeling and development of sex-informed diagnostic algorithms. Building upon this clinical and digital foundation, we have recently initiated an integrated endocrine screening strategy through collaboration with the AI-based Thyroid Screening (AITS) platform. We collaborated with Cosmic Corporation, the developer of the AI-based Thyroid Screening (AITS) system. AITS is an AI-based screening system that analyzes routine blood test results obtained in general screening programs, including health checkups, to estimate the likelihood of thyroid dysfunction. The integrated WaiSE–AITS system combines patient-reported symptom assessment through WaiSE with objective clinical indicators derived from AITS to assist in identifying individuals who may require additional thyroid function testing. The integrated system is being developed with the aim of future regulatory approval as Software as a Medical Device (SaMD). This integrated platform can be utilized in clinical practice settings as well as in health screening programs and occupational health settings, demonstrating feasibility in capturing real-world symptom data beyond hospital-centered care. The combined system is designed as a physician-supervised clinical decision-support tool intended to assist healthcare professionals in identifying patients who may benefit from further thyroid evaluation, while maintaining physician responsibility for final diagnostic decisions. This presentation highlights the clinical background, digital innovation process, and emerging collaborative screening strategies, demonstrating how bedside endocrinology can evolve into digitally supported precision care incorporating a life-course approach for women. Acknowledgements:This research was supported by AMED (Grant Number: JP21gk0210024h9903) and by grants from METI, Japan.
• Precision Medicine in Diabetes: Perspectives from Asia
  Ronald MaHong Kong, China Speaker Precision Medicine in Diabetes: Perspectives from AsiaPrecision Medicine in Diabetes: Perspectives from Asia Abstract Diabetes is traditionally classified into type 1 diabetes, type 2 diabetes and gestational diabetes as the main forms of diabetes. However, there is increasing recognition that there is significant hidden heterogeneity within diabetes. Resolving this heterogeneity of diabetes can help facilitate personalized treatment and precision medicine in diabetes. For example, identification of specific monogenic forms of diabetes may facilitate tailored choices of diabetes medications. Precision diagnosis also includes the use of biomarkers to correctly identify adults presenting with autoimmune diabetes for appropriate treatment. Recent advances have included the use of clinical characteristics to empower subtyping of adult-onset diabetes through different clustering strategies. Regardless of the approach of subclassification, the essence of diabetes subtyping is to differentiate between individuals with diabetes due to different underlying pathophysiological defects, and hence have different prognosis towards complications or response to treatment. Recent advances in precision prognostics have also highlighted strategies that can identify high-risk individuals for more intensive treatment. An international consortium initiated by the American Diabetes Association and European Association for the Study of Diabetes (EASD) has reviewed the landscape for precision medicine in diabetes to map our current understanding, as well as outline future directions. The ability to resolve the heterogeneity in diabetes, and thereby provide treatment that is best tailored to the underlying pathophysiology, provides exciting opportunities to realize precision medicine in diabetes towards better patient outcomes. References 1. Leslie RD, Ma RCW, Franks PW, Nadeau KJ, Pearson ER, Redondo MJ. Understanding diabetes heterogeneity: key steps towards precision medicine in diabetes. Lancet Diabetes Endocrinol. 2023 Nov;11(11):848-860. 2. Tobias D, Merino J et al, Second International Consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine. Nature Medicine 2023; 29: 2438-2457. Challenging Cases in EndocrinologyIn this meet the professor session, we will use 4-5 case scenarios to illustrate diagnostic challenges around clinical endocrinology and diabetes and discuss management strategies.

• Do We Still Need Confirmatory Testing?
  Mitsuhide NaruseJapan Speaker Update in Primary AldosteronismPrimary aldosteronism (PA) is linked to significantly greater cardiovascular morbidity and mortality than essential hypertension, yet it offers a more favorable prognosis when appropriately treated. Early detection and targeted therapy are therefore essential for achieving optimal long-term outcomes and preserving quality of life. Since the release of the Endocrine Society’s guidelines in 2010, several countries—including Japan—have developed national recommendations (e.g., Endocrine Journal, 2021). This reflects growing awareness and research momentum, with over 3,500 publications in the past decade. In Japan, we have established a national PA registry and conducted multicenter studies under the Japan Primary Aldosteronism Study (JPAS), supported by AMED, resulting in more than 40 publications as Japan-originated evidence. Diagnostic protocols have become increasingly standardized, encompassing initial screening, confirmatory testing, subtype classification via adrenal venous sampling (AVS), and tailored treatment—mineralocorticoid receptor (MR) antagonists for bilateral PA and adrenalectomy for unilateral PA. The integration of PA screening into routine hypertension care, alongside the standardization of diagnostic methods, has led to substantial improvements in clinical practice. However, key challenges remain. These include variability in assay methods (e.g., PRA vs. ARC for renin; CLEIA vs. RIA for aldosterone), which affects diagnostic thresholds; uncertainty regarding optimal cutoffs for screening and confirmatory tests; lack of consensus on AVS protocols (with or without cosyntropin); and ongoing debates over the role of non-invasive imaging and advanced surgical approaches (laparoscopic vs. robot-assisted adrenalectomy). These unresolved issues warrant evaluation through a cost-effectiveness lens. As PA diagnostics become increasingly integrated into hypertension management, a fundamental question emerges: How far should we go in diagnosing PA? This presentation will provide an updated overview of clinical practice and address these critical challenges in PA management.Do We Still Need Confirmatory Testing?
• Skipping Confirmatory Tests: Modern Simplified Pathways
  Ada E. D. TeoSingapore Speaker Modern Simplified Pathways for PA: From Screening to LocalizationBy introducing emerging strategies to enable more accurate non-invasive localization, this session aims to help clinicians reduce reliance on adrenal vein sampling and streamline precision diagnosis in primary aldosteronism.
• From ARR to Subtyping: Practical Strategies for Streamlining Testing, Imaging, and AVS in Daily Practice
  Wasita Warachit ParksookThailand Speaker From ARR to Subtyping: Practical Strategies for Streamlining Testing, Imaging, and AVS in Daily PracticeBy integrating guideline recommendations with current evidence and practical clinical reasoning, this session aims to help clinicians navigate the diagnostic pathway from ARR screening to subtype classification more efficiently, reduce unnecessary testing, and optimize individualized treatment strategies for patients with primary aldosteronism.
• Medical vs Surgical Treatment in 2026: Optimizing MRA Therapy, ENaC Strategies, and Surgical Decision-Making
  Cheng Hsuan TsaiTaiwan Speaker Medical vs Surgical Treatment in 2026: Optimizing MRA Therapy, ENaC Strategies, and Surgical Decision-Making
• Discussion

• Mechanistic Insights into the Gut–Liver–Brain Axis in MASLD: Metabolic Crosstalk and Neuroinflammation
  Lee-Ling LimMalaysia Speaker Mechanistic Insights into the Gut–Liver–Brain Axis in MASLD: Metabolic Crosstalk and NeuroinflammationThe gut–liver–brain axis plays an important role in the pathogenesis and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). Disruptions in gut microbiota, increased intestinal permeability, and microbial metabolites drive hepatic lipotoxicity and systemic inflammation. These hepatic signals, together with other metabolic dysfunctions, worsen neuroinflammatory responses and metabolic dysregulation. This lecture will discuss mechanistic links across the axis, and understanding these interconnected mechanisms offers opportunities to refine risk stratification and develop targeted interventions that address MASLD as a multisystem disease.Early-Onset Diabetes: Expanding the Spectrum of ComplicationsEarly-onset diabetes is increasing globally and is characterized by an accelerated trajectory of metabolic dysfunction. People diagnosed at a younger age experience a longer lifetime exposure to hyperglycaemia, adiposopathy, and inflammation, leading to an expanded spectrum of complications. Emerging evidence highlights earlier onset of kidney disease, heart failure, fatty liver disease, cognitive decline, and mental health disorders in this high-risk population. This lecture will synthesize current epidemiology, mechanistic insights, and evolving phenotypes, underscoring the urgent need for precision prevention, aggressive risk-factor modification, and integrated care models to reduce premature morbidity and mortality.
• MASLD and Cognitive Impairment Correlate with Diabetic Management
  Noriko Satoh-AsaharaJapan Speaker MASLD and Cognitive Impairment Correlate with Diabetic ManagementIn recent years, the coexistence of metabolic dysfunction–associated steatotic liver disease (MASLD) and cognitive decline in patients with diabetes has attracted growing attention. These conditions are not merely concurrent comorbidities but share common pathophysiological mechanisms involving insulin resistance, chronic inflammation, and gut dysbiosis. Using a large health checkup database, we reported that a body weight gain of more than 10 kg since the age of 20 is a significant risk factor for the development of MASLD (Nutrients, 2025). Moreover, we found that subsequent weight reduction markedly attenuated this risk, emphasizing the importance of appropriate weight management. In our multicenter diabetic cohort studies of the National Hospital Organization (JOMS/J-DOS2), we reported that circulating soluble TREM2 (sTREM2) —a receptor specifically expressed in monocytes and microglia—was significantly associated with cognitive decline in patients with diabetes, suggesting its potential as a predictive biomarker for dementia (Diabetes Metab, 2019; Front Endocrinol, 2022). Furthermore, our network meta-analysis in patients with type 2 diabetes revealed that SGLT2 inhibitors, GLP-1 receptor agonists, and thiazolidinediones may reduce the risk of cognitive impairment (Diabetes Obes Metab, 2025). Novel antidiabetic agents, particularly GLP-1 receptor agonists, have been shown to improve hepatic function and preserve cognitive performance. Collectively, these findings suggest that optimized diabetic management may hold the key to preventing both MASLD and dementia. In this presentation, I would like to summarize recent evidence and discuss optimal therapeutic strategies for MASLD and cognitive impairment in patients with diabetes.
• Diabetes Mellitus-Dementia Correlate with Diabetic Management
  Chaur-Jong HuTaiwan Speaker Diabetes Mellitus-Dementia Correlate with Diabetic ManagementDiabetes mellitus (DM) is a major metabolic disorder that substantially increases the risk of cognitive decline and dementia, including Alzheimer’s disease (AD) and vascular dementia. Growing evidence indicates that chronic hyperglycemia, insulin resistance, vascular injury, oxidative stress, and neuroinflammation are key mechanisms linking DM to neurodegeneration. Insulin resistance in the brain disrupts neuronal glucose utilization, enhances tau phosphorylation, and accelerates amyloid-β accumulation, while advanced glycation end-products (AGEs) and diabetes-related microvascular dysfunction further exacerbate neuronal injury. Effective diabetic management plays a critical role in mitigating dementia risk. Antidiabetic agents such as metformin, thiazolidinediones, and particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated neuroprotective effects beyond glycemic control. GLP-1RAs improve insulin signaling, reduce neuroinflammation, enhance mitochondrial function, promote autophagy, and inhibit apoptosis, leading to preserved cognitive functions in preclinical models. Clinical studies show that GLP-1RAs may improve specific cognitive domains in patients with type 2 DM and reduce the incidence of cognitive impairment. However, the recent phase 3 trials, Eoke and Evoke+ failed to show the beneficial effects on AD. Overall, the strong interplay between DM and dementia highlights the necessity of optimal glycemic control and strategic use of antidiabetic therapies with neuroprotective potential. Integrating metabolic management into dementia prevention frameworks may offer an effective approach to reducing the global burden of cognitive disorders.

• Consensus in Pituitary Pathology: Impact after New Classification for Japan
  Naoko InoshitaJapan Speaker Consensus in Pituitary Pathology: Impact after New Classification for JapanIn Japan, the brain tumor handling rules are essentially based on the WHO classification. However, the introduction of the term pituitary neuroendocrine tumour (PitNET) has occasionally led to misunderstanding in clinical practice, particularly regarding the implication of malignancy. In this lecture, I will present a consensus-oriented approach in pituitary pathology, focusing on practical strategies developed through multidisciplinary collaboration for the benefit of clinicians and patients. First, I will show how the addition of touch smear cytology to frozen section diagnosis during surgery can improve the accuracy of margin assessment and increase the likelihood of achieving the intended surgical goal, including adequate removal of hormone-producing tumours. Second, I will emphasize that truly malignant PitNETs are extremely rare, and that the term “NET” should not be equated with malignancy. Third, I will discuss the well-known discrepancy between hormone immunohistochemistry and clinical functionality, highlighting the importance of careful pathological interpretation. These perspectives reflect our pathology team’s commitment to accurate communication and clinically relevant pathological diagnosis.
• The Impact of the 2022 WHO PitNET Classification to the Clinical Practitioners. Does Silence Equal Acceptance?
  Szu-Tah ChenTaiwan Speaker The Impact of the 2022 WHO PitNET Classification to the Clinical Practitioners. Does Silence Equal Acceptance?The 2022 World Health Organization (WHO) Classification of Endocrine and Neuroendocrine Tumors redefined pituitary adenomas as pituitary neuroendocrine tumors (PitNETs) within the International Classification of Diseases for Oncology, 3rd Edition (ICD-O/3). This change reflects updated insights into tumor biology, recognizing a spectrum of clinical behaviors beyond the traditionally benign designation. A narrative review of the WHO 2022 classification updates was conducted, focusing on their clinical, diagnostic, and epidemiologic implications for practitioners in endocrinology, neurosurgery, and oncology. The reclassification emphasizes the potential for variability in tumor aggressiveness, recurrence, and invasiveness. Clinically, this shift necessitates more careful risk stratification, closer follow-up in selected cases, and a reassessment of treatment algorithms. From a reporting perspective, ICD-O/3 alignment may affect cancer registry data and epidemiologic tracking, altering disease burden estimates. Importantly, the new terminology presents challenges in patient communication, as the label “neuroendocrine tumor” may cause undue anxiety despite the indolent nature of most PitNETs. The WHO 2022 reclassification of pituitary adenomas as PitNETs represents a significant change for clinical practice. While it enhances awareness of potential aggressive behavior, it also requires balanced application in patient care to avoid overtreatment and misperceptions. Practitioners must adapt by refining diagnostic vigilance, tailoring follow-up strategies, and delivering clear patient-centered communication.
• Consensus in Pituitary Pathology: Impact after New Classification for Korea
  Jae Sung ParkSouth Korea Speaker Consensus in Pituitary Pathology: Impact after New Classification for KoreaThe management of pituitary neuroendocrine tumors (PitNETs) in South Korea is undergoing a significant transition following the 2022 WHO classification. While the shift from "adenoma" to "PitNET" implies a malignant potential, from a neurosurgical perspective, these tumors remain generally far more indolent than primary brain cancers such as high-grade gliomas. Identifying the specific subset of patients who require aggressive intervention is therefore paramount. Our recent institutional study indicates that high-risk non-functioning pituitary adenomas (NFPAs) are more prevalent in younger female patients and exhibit a higher incidence of cavernous sinus invasion. Consequently, a more proactive surgical approach is often warranted for these high-risk phenotypes. Beyond clinical considerations, the Korean healthcare system—characterized by government-led cost controls and supplemental private insurance—faces unique challenges. There is a growing trend of patients requesting malignancy-level ICD coding to secure broader insurance coverage, a phenomenon increasingly driven by external socio-economic factors. Although the Korean Brain Tumor Society (KBTS) previously debated this classification, a definitive consensus remains elusive. Rather than proposing a singular solution, this session aims to raise these multi-faceted issues from a neurosurgical viewpoint, inviting diverse expert perspectives to foster a collective dialogue on the nature of PitNETs within our evolving medical and socio-economic landscape.

• Brain Remodeling of Appetite Centers in Obesity - Results from Murine Omics Studies and Human Brain Imaging
  Tomohiro TanakaJapan Speaker Brain Remodeling of Appetite Centers in Obesity - Results from Murine Omics Studies and Human Brain ImagingBody weight is regulated by functional interplay between multiple organs, among which the hypothalamus plays a critical role through its modulatory functions on energy intake and expenditure. In early 1900s, professors Joseph Babinski and Alfred Frolich reported a case of acquired hypothalamic obesity, whose obesity was secondary to hypothalamic damage by brain tumor. The case provides the first evidence that the hypothalamus plays a key role in the maintenance of body weight in humans. In the 1970s and 1980s, experimental injury or electrical stimulation of the hypothalamic nuclei in rodents further led to an elucidation of its vital role in body weight regulation. Mechanistic insight has been addressed when the discovery of leptin followed by an elucidation of anorexigenic effect of GLP-1 has cast limelight on the endocrinologic aspect of body weight regulation. In fact, more than a dozen genetic forms of obesity has been reported, each of which is caused by mutations of a single gene with indispensable functions within leptin-hypothalamus axis. However, in routine clinical practice, tumors or genetic abnormalities in the hypothalamus are rarely observed in patients with obesity disease. The question, then, is whether the hypothalamus is functioning normally in such patients with primary obesity disease? In 2012, professor Joshua Thaler and colleagues reported that mice fed a high-fat diet exhibit early activation and proliferation of microglia and astrocytes within the hypothalamus - histologic changes suggestive of "hypothalamic inflammation". Subsequent pharmacologic and knockout mouse studies have demonstrated that this hypothalamic inflammation is not merely a result but a critical cause of obesity. We have studied the molecular landscape and its alterations during the development or the improvement of the obesity disease. Methodologically, our research involves transcriptomic and lipidomic analyses of hypothalamic nuclei in mice, with the aim of elucidating the molecular basis of hypothalamic remodeling observed in obese animal models. We have identified obesity-induced biochemical changes in the hypothalamus, such as inflammation-related transcriptome and region-specific accumulation of arachidonic acid esters. More clinically, we are investigating a potential reverse remodeling of the hypothalamus during weight loss in mouse models. Of note, in human subjects with obesity disease, reversible hypothalamic inflammation has been demonstrated using T2 relaxation time measurements in MRI studies. As such, hypothalamic inflammation, a common feature of hypothalamic pathology in rodents and humans, is attracting more attention as a focus of obesity research. In this session, I would like to discuss more of the status quo and future perspectives of the neuropathologic basis of the obesity disease.
• Obesity Management: What's New?
  Alice KongHong Kong, China Speaker Obesity: What Clinicians Should KnowRapid changes in technology, human behavior and lifestyle over the past few decades have resulted in a dramatic increase in the prevalence of obesity worldwide. Besides social stigmata and psychological consequences, obesity is associated with escalated risks of type 2 diabetes, coined the term "Diabesity", hypertension, dyslipidemia, sleep apnoea, metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), polycystic ovarian syndrome, cancers, cardiovascular diseases and increased mortality. Body mass index (BMI) is a commonly adopted tool to identify people with obesity. Clinicians should note that the cutoff points of BMI for clinical actions are different between people with obesity from the East and the West, as well as the limitations of BMI in diagnosing obesity. Recently, the Lancet Diabetes and Endocrinology Commission proposed a new definition of obesity which differentiates excess adiposity with obesity-related illness (clinical obesity) from those without obesity-related diseases (pre-clinical obesity). Also, people with clinical obesity have many unmet needs requiring personalized treatment regimens, intensive counselling and emotional support. The 5 A's framework including Ask, Assess, Advise, Agree and Assist, provide a patient-centred approach to promote lasting behavioral change in obesity management. In addition to lifestyle modifications and behavioral changes, pharmacological agents for weight reduction, bariatric and metabolic surgeries are therapeutic options requiring careful selections for the appropriate patients with adequate counselling of the risks and benefits. Through case sharing approach, the use of weight reducing drugs and surgical strategies for people with preclinical and clinical obesity will be discussed in this session. Acknowledgement: The work described in this lecture was partially supported by funding from Health and Medical Research Fund (HMRF), Food and Health Bureau, Hong Kong SAR, China (Reference number:21223391), Matching Grant from Research Grants Council (reference number: 8601556), and Area of Excellence Scheme, Research Grants Council, Hong Kong SAR, China (Reference number: AoE/M-401/24-R). Obesity Management: What's New?Obesity is a global health hazard with rising prevalence in most parts of the world. Weight reduction by lifestyle modification remains the cornerstone in the prevention and treatment of obesity. However, weight management by lifestyle therapy alone is difficult to sustain in many obese individuals with rebound of body weight being observed as a common phenomenon. Given the invasiveness of bariatric and metabolic surgeries which are not accepted by many people with obesity, the use of pharmacological agents in weight management is increasingly popular. In 2025, the Lancet Diabetes and Endocrinology Commission proposed a new definition of obesity which differentiates excess adiposity with obesity-related illness (clinical obesity) from those without obesity-related diseases (pre-clinical obesity). Among the various obesity complications, diabetes is well recognized to be closely related to obesity, with the term 'Diabesity' coined to show the strong link between these two important modifiable risk factors of cardiovascular disease and premature death. In recent decades, many new generation anti-diabetic drugs are developed and found to have weight reducing properties. Looking ahead, more new drugs are in the pipeline of clinical trials, and the results may eventually change the landscape of obesity management. Acknowledgement: The work described in this lecture was partially supported by funding from Health and Medical Research Fund (HMRF), Food and Health Bureau, Hong Kong SAR, China (Reference number:21223391), Matching Grant from Research Grants Council (reference number: 8601556), and Area of Excellence Scheme, Research Grants Council, Hong Kong SAR, China (Reference number: AoE/M-401/24-R).
• The Hidden Barrier: Understanding and Overcoming Weight Bias
  Hai-Hua ChuangTaiwan Speaker The Hidden Barrier: Understanding and Overcoming Weight Bias

• Incretin-Based Therapeutics: Bridging Theory and Practice, and Exploring New Horizons
  Daisuke YabeJapan Speaker Advancing toward a Cure for Diabetes: Insights from iPSC-Derived Islet Cell Transplantation TrialType 1 diabetes is characterized by absolute insulin deficiency and marked glycemic variability, creating a constant challenge for individuals who must maintain strict glycemic control to prevent complications and severe hypoglycemia. To address these persistent unmet medical needs, transplantation of pancreatic islet–like cells derived from embryonic stem (ES) or induced pluripotent stem (iPSC) cells has emerged as a promising therapeutic strategy. Encouraging advances have recently been reported from the United States and China. Notably, a world-first autologous transplantation of patient-specific iPSC-derived islet-like cells in China achieved insulin independence with near-normal glycemic control. Despite its promise, concerns remain regarding long-term safety, durability, and broad applicability, underscoring the need for further rigorous clinical evaluation. This lecture will provide an overview of current progress and ongoing challenges in β-cell replacement therapy aimed at curing type 1 diabetes. In addition, I will introduce the study design of our clinical trial at Kyoto University Hospital evaluating allogeneic transplantation of iPSC-derived islet cell sheets (OZTx-410). Through these insights, we aim to highlight both the steady steps already taken and the horizon of possibilities ahead in the pursuit of a functional cure for diabetes.Incretin-Based Therapeutics: Bridging Theory and Practice, and Exploring New HorizonsThe landscape of type 2 diabetes management has been transformed by the advent of incretin-based therapies, including dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. In Japan—where more than 70% of individuals with diabetes are aged 65 years or older and commonly present with a non-obese phenotype and reduced insulin secretory capacity—DPP-4 inhibitors continue to serve as a fundamental treatment option, offering effective glycemic control with minimal risk of hypoglycemia. In contrast, among younger adults with obesity, GLP-1 receptor agonists have emerged as essential agents that not only improve glycemic control but also promote weight reduction and confer cardiovascular and renal benefits. A major advance in 2023 was the approval of tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist that engages both receptors. Tirzepatide has demonstrated robust glucose-lowering and weight-reducing effects in both clinical trials and real-world practice in Japan, further expanding therapeutic opportunities across the region. However, incretin-based therapies are not without challenges: gastrointestinal adverse events remain common, and potential associations with pancreatic and biliary diseases continue to require caution. In older adults, concerns regarding their impact on frailty and sarcopenia demand careful clinical judgment. Furthermore, inappropriate discontinuation of insulin therapy after initiating incretin treatment has occasionally resulted in severe clinical consequences, highlighting the critical need for decision-making that extends beyond the evidence from controlled trials. In response to these issues, the Japan Diabetes Society (JDS) Committee for the Safe Use of Medications released the Recommendations for the Safe Use of Incretin-Related Agents, Second Edition in 2024. Disseminating these recommendations across East Asia and the broader Asia–Oceania region will be essential to ensure the safe and effective application of incretin-based therapies in diverse clinical settings. In this plenary lecture, I will explore strategies to optimize type 2 diabetes management in Asia by harnessing the therapeutic potential of incretin-based agents while proactively mitigating associated risks. Together, we aim to build a future in which innovation, safety, and patient-centered care advance hand in hand.