Introduction: Gestational diabetes mellitus (GDM) increases risks for type 2 diabetes and cardiovascular diseases. Low glycaemic index (GI) diets improve cardio-metabolic outcomes in insulin-resistant individuals. We examined the feasibility of lowering GI through GI-based-education among Asian post-GDM women. Methods: A 3-month investigation was carried out on 60 Malaysian women with a mean age of 31.0±4.5 years and a history of GDM. Subjects were randomised into two groups: LGIE and CHDR. The CHDR group received conventional healthy dietary recommendations only. The LGIE group received GI based-education in addition to conventional healthy dietary recommendations. At baseline and after 3-months, dietary intake of energy and macronutrient intakes including GI diet and glycaemic load was assessed using 3-day food records. Diabetes-Diet and GI-concept scores and physical activity levels were assessed using a questionnaire. Adherence to dietary instructions was measured at the end of 3 months. Results: At the end of 3 months, the LGIE group had significant reductions in energy intake (241.7±522.4Kcal, P=0.037, ES=0.463), total carbohydrate (48.7±83.5g, P=0.010, ES=0.583), GI (3.9±7.1, P=0.017, ES=0.549) and GL (39.0±55.3, P=0.003, ES=0.705) and significant increases in protein (3.7±5.4g, 0.003, ES=0.685) and diet fibre (4.6±7.3g, P=0.06). The CHDR group had a significant reduction in fat only (5.7±9.4g, P=0.006, ES=0.606). There was a 30% increase in GI-concept scores in the LGIE group (p< 0.001). Changes in GI-concept scores correlated significantly to the reduction in dietary GI (r = -0.642, P=0.045). Dietary adherence was comparable in both groups. Conclusion: GI-education improves GI-concept knowledge and helps lower dietary glycaemic index among women with a history of GDM.

Aim: This prospective, single-group, pre-post design trial was conducted to evaluate the effect of individualised Medical Nutrition Therapy intervention administered by a dietitian in individuals with type 2 diabetes mellitus on glycaemic control, metabolic parameters and dietary intake. Methods: Subjects (n=104; age=56.4 +9.9 years; 37% male; years of diagnosis = 6.3 +4.9 years) treated with diet and on a stabile dose of oral anti-diabetic agents were given dietary advice by a dietitian for a 12 week period. Individualised dietary advice was based on Malaysian Medical Nutrition Therapy for adults with type 2 diabetes mellitus. The primary outcome measure was glycaemic control (fructosamine and HbA1c level) and the secondary outcome included measures of anthropometry, blood pressure, lipid profile, insulin levels dietary intake and knowledge on nutrition. Results: At week 12, 100 subjects completed the study with a dropout rate of 3.8%. The post-Medical Nutrition Therapy results showed a significant reduction of fructosamine (311.5 +50 to 297 +44 umol/L; p< 0.001) and HbA1c (7.6 +1.2 to 7.2 +1.1 %, p<0.001) with pronounced reduction for subjects who had very high HbA1c levels of >9.3% at baseline. Waist circumference (90.7 +10.2 to 89.1 +9.8 cm, p<0.05), HDL-cholesterol (1.1 +0.3 to 1.2 +0.3 mmol/L, p<0.05), dietary intake and nutrition knowledge score (42 +19 vs. 75 +17%; p< 0.001) were significantly improved from the baseline. Conclusions: Individualised Medical Nutrition Therapy administered by a dietitian resulted in favourable diabetes outcomes, which were more apparent for individuals with higher than optimal HbA1c levels at the start of the study.

Introduction: Adrenal cell carcinoma (ACC) is a rare malignancy and often presents in the advanced stages. Clinical presentation varies depending on the type of ACC and whether the tumour is functional or non-functional. We report our experience with ACC encountered over seven years (2005 to 2011). Material and Methods: All patients diagnosed and treated for ACC in our institutions were identified and data collected were collected and retrospectively analysed. Diagnoses of ACC were made based on: histology, combination of imaging and laboratory investigations. Results: There were seven patients (Chinese, n=5 and female, n=4) with a median age of 39 years old (range 17 to 52) treated at our institution during this period. Four patients had functional cortisol producing tumours. In most, radical surgery was carried out with mitotane used as adjuvant therapy. Hypercortisolism was controlled using mitotane in most, and etomidate in one case. In the other three patients with non-functional tumours, the tumours were generally large at presentation and diagnosis. Conclusion Although the overall prognosis of ACC is limited, the prognosis of the functional tumours is influenced by the success in re- ducing hormonal excess, whereas, in the non-functioning type, radical surgery seems to prolong sur- vival.

Introduction: Post-prandial hyperglycemia is an important independent risk factor in the development of cardiovascular disease in diabetes. This randomised cross-over study was conducted to compare the post-prandial glycemic and insulin responses to both high and low glycemic index (GI) meals in patients with type 2 diabetes (T2DM). Methods: A total of 41 patients with established T2DM (16 males, 25 males, Age= 55 ± 10 years and BMI = 27 ± 4kg/m²) were randomly given either a High GI or a Low GI meal in a cross-over manner. Both test meals were separated by one week washout periods. The meals contained almost the same amount of energy and macronutrients with the exception of the GI values (High GI=70 vs Low GI= 36). Venous blood was taken through an indwelling catheter periodically at 0, 30, 60, 90, 120, 150 and 180 minutes respectively. The incremental area under the curve (iAUC) was used to calculate the post-prandial glycemia and insulin excursion over the 3-hour period. Results: The low GI meal induced lower glycemic responses at times 30,60,90 and 120 minutes (mean±SE; low GI=8.1±0.4, 9.1±0.4 and 8.9±0.4 and 8.5±0.4mmol/l vs high GI=9.1±0.4, 10.7±0.4, 11.0±0.5 and 9.7±0.5mmol/l) and reduced the insulin levels at time 60,90,120 and 150 minutes (mean±SE; low GI=215.93±15.9mmol.L/minute vs high GI=419.52±32.7mmol.L/minute) and insulin (mean±SE;low GI=1439.76±226 vs high GI=2372.76±317mIU.ml/min) curves were lower after the low GI than high GI meal respectively (p<0.05). Conclusion: The low GI meal has the ability to reduce the post-prandial hyperglycemia as well insulin responses in type 2 diabetes patients.