After six years of continuous, regular and timely publication of high quality endocrinology articles from the Southeast Asian region, we are pleased to announce that JAFES is now indexed in Scopus, one of the largest abstract and citation databases of peer-reviewed literature. Along with our efforts of adopting international standards, shifting to 100% open access, and using technologies such as our Open Journal Systems-based website, CrossRef digital object identifiers for all published articles, and Similarity Check for plagiarism detection, our being indexed is aligned with the goal to make scientific output from the region global.

The Asia-Pacific region carries a high disease burden, with over half of the global diabetic population residing in thisregion. Increasing evidence shows that without targeted intervention, the progression from impaired glucose tolerance(IGT) to type 2 diabetes occurs more frequently in Asians compared with Caucasians. Furthermore, IGT is independently associated with an increased risk of cardiovascular disease, and should be managed as early as possible. Because diabetes is now a major public health issue, strategies aimed at prevention and treatment areurgently required. Lifestyle modification, including weight loss, dietary changes and increased physical activity, play a major role in controlling the disease. Significant evidence also supports the effectiveness of a combination of lifestylemodification and pharmacologic therapy, such as metformin, in delaying the onset of diabetes. Although the importanceof lifestyle interventions is well recognized throughout Asia, many countries do not have formal recommendations to guide the diagnosis and management of individuals at risk of progression to diabetes. At a recent regional meeting,experts from the Asian region convened to develop consensus recommendations to guide clinicians in themanagement of Asian patientswith pre-diabetes. These consensus recommendations provide a clear and conciseapproach to the management of individuals with IGT based on the available evidence and current best clinical practice.
Glucose Intolerance ; Asia

Objectives: The increasing use of the Internet as a source of health information makes the accuracy of such information crucial. An example is the use of the widely advertised bitter melon (Momordica charantia) in treating diabetes despite its unproven efficacy. This study aims to assess the accuracy of websites containing information on bitter melon’s role in diabetes, to search for the presence of the proposed quality indicators, and to determine their correlation with accuracy. Methodology: An Internet search was used to generate a list of websites. The accuracy of each website was determined by comparing its content with that of a tool that was developed from authoritative sources. The presence of the proposed quality indicators, taken from published guidelines, was then correlated with accuracy. Results: Of the 158 websites identified, 10 (6.33%) were characterized as “most accurate” and 21 (13.3%) as “somewhat accurate.” The identified indicators of accuracy were the HONcode logo (OR 12.1, p=0.011); the author, identified as a healthcare professional (OR = 6.11, p = 0.008); and a citation from a peer-reviewed medical literature (OR 2.92, p = 0.029). Conclusion These findings suggest that most of the Internet-based information on bitter melon’s role in diabetes is inaccurate. The public can use several indicators of accurate information on the use of bitter melon in diabetes to improve health care.
Internet ; Momordica charantia

Objectives: To evaluate the safety and efficacy of heparinoid supplementation on all-cause mortality and disease progression in diabetic kidney disease (DKD). Methodology: Trials evaluating heparinoid supplementation in DKD were included. Two authors performed a literature search with eligible studies undergoing validity screen, data extraction, and statistical analysis. Results were calculated using the Mantel-Haenszel odds ratio for dichotomous variables and the inverse variance method for continuous variables, and pooled using a random or fixed effects model depending on heterogeneity Results: Twelve trials were included in the analysis. Eight involved sulodexide while two each involved low molecular weight heparin and danaparoid. We found no statistically significant difference between the heparinoid and placebo groups for all-cause mortality (95% CI, HR 0.79 [0.41, 1.53], p=0.49), number of patients reaching therapeutic success (95% CI, OR 0.97 [0.71, 1.33], p=0.87), serum creatinine (95% CI, MD 2.55 umol/L [-0.54, 5.65], p=0.11), and creatinine clearance (95% CI, MD -8.55 mg/min [-18.28, 1.18], p=0.09). We also found no statistically significant difference in urinary albumin excretion rate (UAER) between Type 2 heparinoid-treated DKD patients compared to placebo (95% CI, log transformed MD 0.13 mg/24h [-0.42, 0.68], p=0.65); however, a statistically significant UAER reduction was seen in Type 1 heparinoid-treated DKD patients compared to placebo (95% CI, log-transformed MD -1.5 mg/24h [-2.79, -0.21], p=0.02). This subgroup analysis was performed due to initial heterogeneity (I^2=57%). Conclusion Heparinoid supplementation was not associated with statistically significant changes in Type 2 DM patients. However, it may be associated with a statistically significant UAER reduction of approximately 31.62 mg/24 h as compared to placebo in Type 1 DM patients. Due to sparse data on hard clinical outcomes, larger studies are recommended.
Diabetes Mellitus ; Diabetic Nephropathies ; Heparinoids ; Meta-Analysis

Objectives: To compare the maternal and perinatal outcomes in women with GDM diagnosed by Carpenter & Coustan (CC) criteria and by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Methodology: A cross-sectional comparative study was conducted using data of women who were screened and diagnosed with GDM between April 2006-March 2007 using the CC criteria and April 2013-March 2014 using IADPSG criteria. Maternal and perinatal outcomes were noted. Means and proportions were calculated for continuous and categorical variables respectively. Data were analyzed using t-test for normally distributed data and Mann-Whitney U test for those that were not normally distributed. Pearson Chi-square test was used to find an association between the various outcomes between the two groups. Results: Among 500 pregnant women screened, 36 were diagnosed GDM in the CC group. In the IADPSG group, 733 women were screened and 167 were diagnosed GDM. Prevalence of GDM was 7.2% in CC group and 22.78% in IADPSG group (p=0.000). There was a statistically significant difference in the number of women who developed hypertension and polyhydramnios among the two groups. Women who had an operative vaginal delivery (16.67% vs. 6.6%, p=0.085) and mean birth weight (3.10±0.55 kg vs. 2.97±0.48 kg, p=0.165) were higher in CC group than the IADPSG group. Among the perinatal outcomes, a statistically significant improvement was found in the number of neonates developing respiratory distress syndrome (p=0.000) and hyperbilirubinemia (p=0.000), when the IADPSG criteria were used. Conclusion There is a statistically significant difference between the maternal and neonatal outcomes when the newer IADPSG criteria were used for diagnosis of GDM.
Diabetes, Gestational ; Prevalence

Background: Diabetes mellitus (DM) has been shown to be associated with an increased risk for hepatocellular carcinoma (HCC). DM and obesity are coexisting conditions that can increase the risk and severity of nonalcoholic fatty liver disease (NAFLD), leading to HCC even in the absence of cirrhosis. With the rising incidence of HCC and DM worldwide, it is important to identify the clinical characteristics of individuals with DM among those with HCC in our local setting. Objectives: To determine the prevalence of DM among Filipino patients with HCC at our institution, determine their demographic and clinical profile, and compare the characteristics of HCC patients with and without DM. Methodology: This is a retrospective, analytical, cross-sectional study involving patients with HCC seen at The Medical City’s Center for Liver Disease Management and Transplantation from January 2010 to December 2014. A chart review was conducted and patients were grouped according to the presence or absence of DM. Data on demographics, body mass index (BMI), comorbidities, social and family history, risk factors for liver disease, and laboratory test results were gathered. STATA 12.0 was used for data analysis. Results: We included 180 patients with HCC in the analysis. The prevalence of type 2 DM and prediabetes was 52.78%. The median age of patients with DM and prediabetes was 65 years, and 58 years for patients without DM (p=0.002). The average BMI was 27.35+4.68 for patients with DM, and 25.04+5.11 for those without DM (p=0.002). Among the patients without DM, 50.59% had hepatitis B virus (HBV) infection compared to 24.21% of patients with DM (p=0.000). Twenty one percent of patients with DM had cryptogenic cirrhosis compared to 8.24% of patients without DM (p=0.016). Patients with DM had a higher proportion of hypertension (66.32% vs 42.35%, p=0.001) and dyslipidemia (48.42% vs 10.59%, p=0.000). Conclusion The prevalence of DM and prediabetes among HCC patients is higher in our institution compared to findings from previous studies. HCC patients with DM were older, and had increased BMI, higher proportion of hypertension and dyslipidemia, lower incidence of HBV infection, and higher incidence of cryptogenic cirrhosis.
Carcinoma, Hepatocellular ; Diabetes Mellitus

Objectives: To evaluate if magnesium supplementation, in addition to standard therapy, improves fasting blood sugar (FBS) and/or glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM) compared to placebo or other comparator. Methodology: We searched MEDLINE/PubMed, Cochrane Library, Acta Medica Philippina, Health Research and Development Information Network (HERDIN) and references of reviewed journals from 1966 to July 2015 using the following search terms: “magnesium” OR “magnesium supplementation” OR “magnesium replacement”, AND randomized controlled trial AND diabetes OR diabetes mellitus OR non-insulin dependent diabetes mellitus OR diabetic OR diab* (with MeSH, where available). Studies were retrieved and rated independently using the standards provided by The Cochrane Collaboration. High quality trials were included in a systematic review and meta-analysis. Results: Of the 689 records screened, 10 studies were included in the qualitative synthesis and 7 studies in the meta-analysis. Pooled data showed a non-significant trend towards improvement in glycemic control in the magnesium-treated group (mean difference -0.19, CI -0.58 to 0.21). There was a stronger but still non-significant trend in T2DM patients with hypomagnesemia (mean difference -1.16, CI -2.92 to 0.6). Conclusion Routine magnesium supplementation for improvement in glycemic control in T2DM patients cannot be recommended based on data from included studies in this meta-analysis.
Magnesium ; Glycemic Control ; Meta-Analysis

Thyroid disorders are prevalent in the paediatric population and untreated hypothyroidism leads to several adverse consequences like mental retardation, neurological impairment, short stature, delayed puberty and increased morbidity. Owing to a wide range of non-specific clinical manifestations, one must have a high index of suspicion for timely diagnosis and treatment of primary hypothyroidism. We describe the case of an adolescent girl who presented with short stature, delayed puberty and feeding difficulties owing to undiagnosed and subsequently untreated hypothyroidism.
Macroglossia ; Puberty, Delayed ; Hypothyroidism

Autoimmune thyroiditis in the course of other autoimmune diseases such as systemic lupus erythematosus (SLE) is common because these disorders are attributed to the production of autoantibodies against various autoantigens. Beyond this association, autoimmune thyroiditis can occur before, during or after the development of SLE. In this report, we describe a female who presented with facial puffiness, lethargy and progressive abdominal distension. She was diagnosed with autoimmune thyroiditis followed by the diagnosis of SLE complicated by a massive ascites, a rare form of lupus peritonitis, which is sterile ascites that results from severe serositis. Her presentation was complex and posed a diagnostic challenge and dilemma to the physicians involved in her care.
Thyroiditis, Autoimmune ; Lupus Erythematosus, Systemic ; Serositis

For ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS), when surgery is not feasible, or in cases of severe biochemical disturbances, immunosuppression or mental instability, medical therapy with agents such as etomidate is indicated. We present our experience in using etomidate for a 41-year old female with EAS secondary to a malignant mediastinal paraganglioma. We were able to demonstrate that etomidate can be used effectively to control severe hypercortisolism in a lower dose than previously described.
Etomidate ; ACTH Syndrome, Ectopic ; Cushing Syndrome