Stuff that occurs to me

All of my 'how to' posts are tagged here. The most popular posts are about blocking and private accounts on Twitter, also the science communication jobs list. None of the science or medical information I might post to this blog should be taken as medical advice (I'm not medically trained).

Think of this blog as a sort of nursery for my half-baked ideas hence 'stuff that occurs to me'.

Contact: @JoBrodie Email: jo DOT brodie AT gmail DOT com

Science in London: The 2017 scientific society talks in London blog post

Monday, 29 March 2010

BBC Radiophonic Workshop - Alchemists of Sound 2003

The shortened URL for this post is http://is.gd/b5rA2

Alchemists of Sound (2003): BBC Radiophonic Workshop Length: 1hr
Filetype: wmv (175Mb) or avi (700Mb) - right-click / save as definitely works, no idea if it'll stream (try!). I watch it using the free VLC (VideoLAN) player which is fab.

The whole programme is also available, in smaller chunks, at YouTube (part one) and it abounds on the internet. Further information on the programme from BBC's website




This is a documentary I watched at 8pm one evening in 2005 and was so enchanted I stayed up to watch the repeat at 3am. Then I was straight on to the internet the next day at work to hunt it down or see if I could buy a copy from the BBC / 2Entertain (nope, no plans to release it that I'm aware of).

If you've not seen this and you delight in strange and quirky sounds, and in the ingenious ways in which these sounds were turned into an acoustic backdrop (or actual music) using tape loops to record raw sound and manipulate it, then this is a suitable programme for you. It's the slightly spooky soundtrack to some of my childhood.

Narrated by Oliver Postgate it also features interviews with the workshop geniuses and some others, including Robert Popper and Peter Serafinowicz who gave us "Look Around You".

In 1991 there was an exhibit called "Behind the Sofa" at the now defunct Museum of the Moving Image by Waterloo, London - I remember all sorts of Dr Who memorabilia being on show but the bit that made me smile in particular was the panel of buttons which let you hear the various versions of the theme tune. Magic :)

Here's a video of the Dr Who theme tune, recorded live at the Radiophonic Workshop's gig at the Camden Roundhouse last year (I didn't record it but I was there enjoying it).

Tuesday, 16 March 2010

Some thoughts on herbal remedies and diabetes

A shortened link for this post is http://is.gd/aJEfH

Medicines from plants
There are many preparations containing plant ingredients which have been claimed to help people with diabetes manage their condition. As well as the sugars, proteins and fats (oils) that plants use for fuel, storage and building blocks, plants produce many other chemicals that protect them from being eaten (for example by herbivorous animals) and help in repairing damage. Many of these chemicals have effects (whether these are beneficial or negative is often be a consequence of dose, as much as of the nature of the molecule(s) involved) in humans and have for years been exploited in medicine.

Aspirin tablets contain a chemical which has its origin in a similar chemical found in the bark of the willow tree (Salix alba) and in the woody shrub known in North America as meadowsweet (from the Spiraea family). Similarly metformin, used in the treatment of Type 2 diabetes, is a safer synthetic form of a chemical compound originally found in French lilac (Galega officinalis). A significant number of modern day pharmaceutical preparations have their origins in chemicals extracted from plants and so it is not unreasonable for people to think that plant material may be helpful in treating diabetes and other conditions.

Herbal preparations are sometimes wrongly advertised as being safer alternatives to prescription medications because they contain only natural ingredients. However it is important to remember that 'natural' does not necessarily mean 'harmless', an example being the poison ricin which is extracted from the castor bean plant (Ricinus communis).

Claims are also often made for herbs and spices which are typically used at relatively low doses in flavouring foods. At higher doses these same herbs or spices may begin to have pharmacological effects on the body and it may not be safe to take them for a long time at such high doses. In addition to the active ingredient some plants contain other chemicals that can also be harmful at higher doses.

It is important to remember that herbal preparations, and other alternative treatments, can contain:

  • an active ingredient which may be harmful
  • an active ingredient which may not be harmful by itself but which may interact with other prescribed medication(s) which can cause that medicine to work differently and can also worsen the risk of a serious hypo (low blood glucose)
  • adulterants – that is other chemicals added to the preparation, for example prescription-only medicines, medicines that have been withdrawn (Wood, 2004) or heavy metals sometimes found in Ayurvedic treatments
  • ingredients which have no or insufficient effect on blood glucose control, or which contain no ingredients at all.

I’ve previously tried to find out how harm can be categorised as I’ve assumed someone must have arrived at this problem before me… any ideas?

I'm not aware of any good evidence recommending that any herbal preparation can be effectively or safely used to treat diabetes but of course this wouldn't prevent someone from trying a treatment if they wanted to. My advice, such as it is - I am not medically trained and there's the potential to do oneself quite a lot of harm with alternative treatments, is to take a pragmatic approach to herbal products.

I'd suggest that people with diabetes discuss them with their doctor or healthcare team, consult their pharmacist for advice about any known interactions and, if appropriate, monitor their blood glucose levels more closely to prevent hypos (low blood glucose levels) or to make sure that glucose levels do not rise. If someone with diabetes needs any changes to prescription medication, this should really only be done on the advice of a medically qualified doctor.

Avoid buying products from the internet – moneyback guarantees mean very little – and ignore hype, and patient testimonials (which are unlikely to be real).

References (see also in-text links)
Wood, DM, Athwal, S and Panahloo, A (2002) The advantages and disadvantages of a 'herbal' medicine in a patient
with diabetes mellitus: a case report. Diabetic Medicine, 21 (6): 625-627.
Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/15154951

A 48 year old man improved his diabetes management in the short term, and stopped taking other medication, after using herbal 'balls' purchased in India. It was subsequently discovered that the herbal preparations contained chlorpropamide, a prescription-only medicine that is no longer recommended in treating diabetes.

Recommended reading
Shane-McWhorter, L (2007) Complementary & alternative medicine (CAM) supplement use in people with diabetes: a clinician's guide. American Diabetes Association, Alexandria, Virginia.

See also
Campbell, AP (2010) Diabetes and dietary supplements Clinical Diabetes website.
Article available from http://clinical.diabetesjournals.org/content/28/1/35.full

Wednesday, 10 March 2010

Post for @garwboy

This post is non-canonical and is logically equivalent to Twitlonger except I decided to put it here :)

Some suggestions
ABSW has a Christmas party and might like to hear your amusing and entertaining stories, mind you if it's vastly critical of the media probably it won't go down awfully well given that it's the Association of British Science Writers (of which I'm a member).

The British Science Association (nee The BA) has an annual Science Communication Conference coming up in May - I don't know how much of the programme is in place but they do often end with a bit of entertainment after the final plenary. You could be that entertainment...

The Science Media Centre, based at the RI, hosts half-day sessions for scientists to hear more about working with the media. The purpose of these is to encourage scientists to get involved, and early on in their careers, and communicate their work via the media. If your stories include things about what not do to, that might work. I believe Wellcome may also host something similar, and possibly the Royal Society - but I might be wrong.

Cancer Research UK do their own in-house training for their own scientists in talking about the research that the scientists do and which Cancer Research UK fund - they may not need any further input but you can but ask.

You could ignore the media-mediator concept entirely and just go to the science departments in universities or to the professional societies and give them a presentation discouraging them from talking to the media - however I wouldn't seriously suggest this as being a good idea, and would actively discourage you from doing this myself, somewhat ironically.

I don't know of any publications that would be particularly interested in this, with the emphasis being 'I don't know' rather than implications that they wouldn't be interested. I'm guessing they wouldn't rush to publish stuff that might be a bit 'insulting' to them but depends how you're pitching your material.

That's all I can think of at this precise moment...

Tuesday, 9 March 2010

Thiamine or benfotiamine use in people with diabetes

This is another draft document (see yesterday's on glucosamine and chondroitin) - written by me and no-one else - based on my reading of the literature. It might be wrong and I would strongly advise anyone reading to consider this 'preliminary' and to take any medical advice not from me (not medically trained) but from their own doctor / healthcare team.

Having said that, I'd be grateful if you told me if this did or didn't make sense - or if you think I've missed an important paper or given undue weight to a less important one.

A short URL for this page is http://is.gd/a3kR8

Thiamine or benfotiamine use in people with diabetes
The Vitamin B complex is a group of water-soluble vitamins including thiamine (vitamin B1), riboflavin (vitamin B2), nicotinic acid (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6), biotin (vitamin B7), folic acid (vitamin B9) and cyanocobalamin (vitamin B12) with other compounds (Ang 2008). All of the B vitamins are required in the diet in very small amounts as these essential substances cannot be synthesised by the body.

Specific vitamin B deficiency diseases in humans include beriberi (thiamine, vitamin B1), megaloblastic anaemia (folic acid, vitamin B9), and pernicious anaemia (cobalamin, vitamin B12); these B vitamins may be of particular importance in people with diabetes.

I'm planning a follow up on folic acid and cobalamins - women with diabetes who are or wish to be pregnant are currently advised to take 5mg (available only on prescription) of folic acid to prevent neural tube defects, and in long-term use of metformin there can be a reduction in the absorption of cobalamin / B12.

Folic acid supplementation in pregnancy
http://www.diabetes.org.uk/about_us/our_views/care_recommendations/folic_acid_supplementation_in_pregnancy/

Metformin SPC (go to section 4.8 - undesirable effects)
http://emc.medicines.org.uk/medicine/1043/SPC/Glucophage+500+mg+and+850+mg+film+coated+tablets/


Thiamine (Vitamin B1)
Recommended levels of thiamine are 1mg a day for men and 0.8mg for women (Food Standards Agency) and up to 1.8mg/day in pregnant or breastfeeding women (Expert group on vitamins and minerals, 2003). Thiamine present in food is efficiently absorbed; however water-soluble supplements may be less well absorbed (Expert group on vitamins and minerals, 2003).

Good sources of Vitamin B1 include "unrefined grain products, meat products, vegetables, dairy products, legumes, fruits and eggs" (Expert group on vitamins and minerals, 2003). Fortification of white and brown flour with thiamine (not less than 0.24mg/100g flour) to replace that lost during processing means that cereal products are also a rich source of this vitamin (Expert group on vitamins and minerals, 2003).

Benfotiamine is a fat-soluble derivative of Vitamin B1 / thiamine and may have greater bioavailability (Stracke 1996).

Thiamine (Vitamin B1) deficiency in people with diabetes
In the general population a severe lack of thiamine, resulting from malnutrition, leads to the deficiency syndrome known as beriberi which is characterised by serious painful neurological and muscular problems, including cardiovascular problems. Heavy alcohol use can also impair the uptake and use of thiamine leading to its deficiency and can result in painful alcoholic neuropathy.

A small pilot study has indicated that people with Type 1 or Type 2 diabetes may be generally deficient in thiamine, perhaps as a consequence of increased renal clearance of the vitamin rather than a lack in the diet or problems with absorption. This may increase the risk of microvascular complications, in particular diabetic kidney disease (Thornalley 2007).

Thiamine or benfotiamine in the treatment of diabetic neuropathy (nerves)
Although thiamine supplementation has been used to treat generalised peripheral neuropathy its effectiveness in this, or in diabetic neuropathy is not clear. A Cochrane review concluded that “there are only limited data in randomised trials testing the efficacy of vitamin B for treating peripheral neuropathy and the evidence is insufficient to determine whether vitamin B is beneficial or harmful” (Ang 2008).

One trial suggested that short-term (eight weeks) use of benfotiamine could improve vibration-perception threshold in people with general peripheral neuropathy (Ang 2008).

The BENDIP (benfotiamine in diabetic polyneuropathy) study, a double-blinded, randomised, placebo-controlled trial funded by a company which produces benfotiamine, compared the effect of two doses (300 and 600mg daily) of benfotiamine on people with diabetic neuropathy (Stracke 2008). This study built on a previous pilot trial (41 patients in a trial of three weeks' duration) which suggested that benfotiamine produced improvements in the symptoms of neuropathic pain (Haupt 2005) without any change in blood glucose levels. The BENDIP trial indicated that the higher dose of benfotiamine was helpful in reducing pain symptoms, though other neuropathic symptoms (eg numbness, burning or the sensation of pins and needles) were not improved.

A Cochrane review of trials using Vitamin B1 or benfotiamine in the treatment of general peripheral neuropathy found that benfotiamine was effective in improving, in the short term, the ability to detect vibrations (Ang 2008).

Thiamine or benfotiamine in the treatment of diabetic nephropathy (kidneys)
A pilot study of 40 subjects with Type 2 diabetes compared the effect on urinary albumin excretion of a high dose of thiamine (3 x 100mg capsules per day) with a placebo pill (Rabbani 2009). Over a period of three months the 20 patients taking thiamine had a decrease in their urinary albumin excretion compared to those taking the placebo and it was reported that the effect of thiamine might persist beyond treatment (the urinary albumin excretion continued to decrease after the treatment had finished) however factors other than thiamine may have contributed to this (Alkhalaf 2009).

This suggests that thiamine supplementation in people with Type 2 diabetes may result in regression of albuminuria (urinary albumin excretion). However the issue of baseline differences between the treatment and placebo groups may mean that the subsequent differences were less significant, particularly given the small size of the two groups (Alkhalaf 2009).

Current or future clinical trials
At the time of writing (May 2010) there are a number of registered trials which are or will examine the effects of thiamine or benfotiamine supplementation in people with diabetes, in particular any effects on the prevention or improvement of microvascular complications including diabetic nephropathy and neuropathy (ClinicalTrials.gov).

References
Alkhalaf A. (2009) Thiamine in diabetic nephropathy: a novel treatment modality? Diabetologia 52(6): 1212-1213.
Available from http://pubget.com/paper/19296076?title=Thiamine+in+diabetic+nephropathy%3A+a+novel+treatment+modality%3F

Ang, CD, Alvia, MJM, Dans AL et al (2008) Vitamin B for treating peripheral neuropathy (review). Cochrane Collaboration, 4.
Available from http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004573/pdf_fs.html

ClinicalTrials.gov – search results
http://www.clinicaltrials.gov/ct2/results?term=benfotiamine
http://www.clinicaltrials.gov/ct2/results?term=thiamine+and+diabetes
http://www.clinicaltrials.gov/ct2/results?term=vitamin+b1+and+diabetes

Expert Group on Vitamins and Minerals (2003) Risk assessment: Thiamin (Vitamin B1) Food Standards Agency
Available from http://www.food.gov.uk/multimedia/pdfs/evm_thiamin.pdf

Food Standards Agency: Thiamin Food Standards Agency website
Available from http://www.eatwell.gov.uk/healthydiet/nutritionessentials/vitaminsandminerals/thiamin/?lang=en

Haupt E et al (2005) Benfotiamine in the treatment of diabetic polyneuropathy - a three week randomized, controlled pilot study (BEDIP study). International Journal of Clinical Pharmacological Therapeutics, 43 (2): 71-77.
Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/15726875

Rabbani, N, Alam, SS, Riaz, S et al ((2009) High-dose thiamine therapy for patients with Type 2 diabetes and microalbuminuria: a randomised, double-blind placebo-controlled pilot study. Diabetologia, 52: 208–212.
Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/19057893

Stracke H, Lindemann A, Federlin K (1996) A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy Exp Clin Endocrinol Diabetes 104 (4): 311-316.
Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/8886748

Stracke H, Gaus W, Achenbach U et al (2008) Benfotiamine in diabetic polyneuropathy (BENDIP): results of a randomised, double blind, placebo-controlled clinical study. Experimental and Clinical Endocrinology and Diabetes, 116 (10): 600-605.
Available from http://www.biovita.fi/uusi/pdf/Stracke_2008.pdf

Thornalley PJ, Babaei-Jadidi R, Al Ali H et al. (2007) High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease. Diabetologia, 50 (10): 2164-2170.
Available from http://ukpmc.ac.uk/articlerender.cgi?artid=1091977

Further reading
Brownlee, M (2004) The pathobiology of diabetic complications: a unifying mechanism. Diabetes, 54 (6): 1616-1625.
Available from http://diabetes.diabetesjournals.org/content/54/6/1615.full.pdf

Manzella D (2007) Is benfotiamine effective for treating diabetic complications? About.com: Type 2 diabetes website.
Available from http://diabetes.about.com/od/whatsonthehorizon/p/benfotiamine.htm

Medline Plus
Thiamin (thiamine), vitamin B1
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-thiamin.html

TRIP (2007) Is there evidence supporting the use of thiamine or benfotiamine to reduce complications in diabetics? If there is what dose would be recommended? tripanswers website
http://www.tripanswers.org/answer.aspx?criteria=&tagtrail=%2fdiabetes%2fbenfotiamine%2f&qid=4059&src=0

Monday, 8 March 2010

Glucosamine and chondroitin: use in people with diabetes for osteoarthritis

This is a draft document - written by me and no-one else - based on my reading of the literature. It might be wrong and I would strongly advise anyone reading to consider this 'preliminary' and to take any medical advice not from me (not medically trained) but from their own doctor / healthcare team.

Having said that, I'd be grateful if you told me if this did or didn't make sense - or if you think I've missed an important paper or given undue weight to a less important one.

A short URL for this page is http://is.gd/a1rlg

Osteoarthritis results from breakdown of the cartilage tissue and occurs particularly in the knee joints, though other joints are affected, and the condition can be very painful and debilitating (The National Collaborating Centre for Chronic Conditions 2008). People with diabetes are already at increased risk of musculoskeletal disorders as raised glucose levels can cause damage to joints and cartilage (see Diabetes UK's information sheet on Musculoskeletal Conditions) as well as contributing to altered bone metabolism (which may also be a consequence of disordered hormone regulation).


Glucosamine and chondroitin are marketed for the treatment of osteoarthritis however NICE (National Institute for Health and Clinical Excellence), in its 2008 guidance for the care and management of osteoarthritis, did not recommend either product in the treatment of this condition (NICE 2008). Some preparations are also marketed for rheumatoid arthritis however evidence for its effectiveness in treating this condition is extremely limited (Drug Update: Glucosamine 2008).

A Cochrane review of 20 randomised controlled trials of glucosamine in pain relief suggested a beneficial effect, however when the review was restricted to those trials not using a named brand and to studies where there was adequate concealment of the treatment or placebo then there were no significant differences between glucosamine and control groups in terms of pain relief (Towheed 2008).

The Guideline Development Group responsible for preparing the Royal College of Physicians report recommends that people wishing to try glucosamine products may benefit from advice on performing their own trial of therapy including evaluating their pain before starting glucosamine (generally at a dose of 1500mg a day) and reviewing any benefits after three months (The National Collaborating Centre for Chronic Conditions 2008).

Regarding chondroitin, a meta-analysis determined that “no robust evidence supports the use of chondroitin in osteoarthritis. Large-scale, methodologically sound trials indicate that the symptomatic benefit is minimal to nonexistent” (Reichenbach 2007).

Preparations used
Synthetic versions of glucosamine and chondroitin are available. People with shellfish allergies are recommended to avoid taking supplements in which the glucosamine has been extracted from the crushed shells of crustaceans.

Safety issues
In addition to shellfish allergy risks mentioned above the MHRA (Medicines and Healthcare Regulatory Authority) has received several reports suggesting an interaction between warfarin and glucosamine (MHRA 2006) and the British National Formulary warns against using these two products together. An earlier report suggested that chondroitin has anticoagulant activity and should be avoided by people taking warfarin or any other anticoagulant medicine (North West Medicines Information Service 2001). The MHRA recommends that people taking warfarin should not take glucosamine supplements.

Animal studies have suggested that glucosamine supplements may affect diabetes by a direct effect on glucose metabolism; however this effect is unlikely to be clinically significant (Drug Update: Glucosamine 2008). In one study glucosamine supplements with chondroitin had no effect on glycaemic control, as assessed by HbA1c, in patients taking oral antidiabetic drugs (Baxter 2010) though one report indicated that ‘unexpected increases in blood glucose levels occurred in diabetic patients using glucosamine sulfate or glucosamine with chondroitin orally’ (Canadian Adverse Drug Monitoring Programme 2007).

Summary and recommendations
Although arthritic conditions occur in people without diabetes they can be worsened by damage caused by hyperglycaemia in people with diabetes who are at risk from other musculoskeletal conditions and improving blood glucose management may help in preventing damage. Glucosamine/chondroitin supplements are not recommended as a treatment for osteoarthritic pain, and pain relief may be better managed through other means, on the advice of healthcare professionals.

References
Baxter, K (2010) Stockley’s Drug Interactions. Pharmaceutical Press
Available from http://www.medicinescomplete.com/mc/stockley/current/ (subscription required).

Canadian Adverse Drug Monitoring Programme (2007) Communiqué: Glucosamine sulfate: hyperglycemia. Canadian Adverse Drug Reaction News 10 (4): 7.
Available from http://dsp-psd.pwgsc.gc.ca/Collection/H12-38-10-4E.pdf

MHRA (2006) Glucosamine adverse reactions and interactions. Current Problems in Pharmacovigilance, 31.
Available from http://www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dDocName=CON2023860&RevisionSelectionMethod=LatestReleased

NICE (2008) Osteoarthritis: the care and management of osteoarthritis in adults. Clinical Guidelines 59.
Available from http://www.nice.org.uk/nicemedia/pdf/CG59NICEguideline.pdf

North West Medicines Information Service (2001) Complementary Medicine: part 2. Drug Information Letter, 119. Liverpool: Medicines Information Centre.
Available from http://www.ukmi.nhs.uk/Newmaterial/html/docs/04020202.pdf

Regional Drug and Therapeutics Centre (2008) Glucosamine. Drug Update, 60.
Available from http://www.nyrdtc.nhs.uk/docs/dud/DU_60_GLUCOSAMINE.pdf

Reichenbach, S, Sterchi, R, Scherer, M et al (2007) Meta-analysis: Chondroitin for osteoarthritis of the knee or hip. Annals of Internal Medicine, 146: 580-590.
Abstract available from http://www.annals.org/content/146/8/580.abstract

The National Collaborating Centre for Chronic Conditions (2008). Osteoarthritis: National Clinical Guideline for Care and Management in Adults. London: Royal College of Physicians. Available from http://www.rcplondon.ac.uk/pubs/contents/d87b4537-b333-4b8a-a2d8-5e96b7f4b65a.pdf

Towheed, TE, Maxwell, L and Anastassiades, TP et al (2005) Glucosamine therapy for treating osteoarthritis. Cochrane Database of Systematic Reviews 2: CD002946
Available from http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002946/pdf_fs.html

Further reading
Anderson, JW, Nicolosi, RJ and Borzelleca, JF (2005) Glucosamine effects in humans: a review of effects on glucose metabolism, side effects, safety considerations and efficacy. Food and Chemical Toxicology, 43: 187-201.
Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/18283204

British National Formulary
Available from http://bnf.org/bnf/bnf/current/41001i222.htm (registration required, free).

Colquhoun, D (2007) Chondroitin doesn't work.
Available from http://www.dcscience.net/?p=81

Marshall PD and Tweed EM (2006) Do glucosamine and chondroitin worsen blood sugar control in diabetes? The Journal of Family Practice, 55 (12).
Available from http://www.jfponline.com/Pages.asp?AID=4627

Regional Drug and Therapeutics Centre (2005) Glucosamine. Drug Update, 43.
Available from http://www.nyrdtc.nhs.uk/docs/dud/DU_43_Glucosamine_a.pdf

Rozendaal RM, Koes BW, van Osch GJ et al. (2008) Effect of glucosamine sulfate on hip osteoarthritis: a randomized trial. Annals of Internal Medicine, 148: 268-77.
Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/18283204

Towheed, T and Anastassiades T (2007) Glucosamine therapy for osteoarthritis: an update. The Journal of Rheumatology, 34 (9): 1787-1790.
Available from http://www.jrheum.org/content/34/9/1787.full.pdf


Further reading
Glucosamine Arthritis Research Care website
http://www.arthritisresearchuk.org/arthritis_information/complementary_therapies/glucosamine.aspx
suggested by @xtaldave

Sunday, 7 March 2010

I am not really sure what Diabetone diabetes tablets are actually for

EDIT:
30 June 2010 - @zeno001 just tweeted
@zeno001 Poor clinical trial not sufficient proof for #ASA - Vitabiotics and diabetes: http://bit.ly/bmu4rs http://twitter.com/zeno001/status/17369803811

I never actually saw the advert that they refer to (amazingly it wasn't actually me that put in the complaint to the ASA!), I heard about this product because someone asked me about it and I looked at the website. What's also noticeable about the ASA complaint is that this event has taken place because of the actions of ONE person.

-------------- Original post ---------------

All views are my own, may be wrong, may be changed with new evidence and additionally I am not medically trained so nothing here should ever be taken as medical advice.


UK pharmacist Boots apparently sells Diabetone tablets (for around £10 for 30 tablets) and the tablets are also available online.

Company website: http://www.vitabiotics.com/Diabetone/

According to the Diabetone website the product is "supported by original published nutritional research" having been formulated to contain the nutrients of "special relevance to people with diabetes". However the actual claims made are that the product may enhance wellbeing in people with diabetes; the product doesn't appear to have any effect on blood glucose management etc.

The short version of this blog post is that this conclusion is drawn from a single study of 29 people with Type 2 diabetes - it's a pilot study, which indicated some improvements in wellbeing when taking the supplements compared with placebo, but I think possibly a bit more research is needed before anyone can really conclude that these pills are doing that much.

The longer version is below...

There's some sensible stuff on the 'More information' section about eating healthily, and some indications that people with diabetes may have reduced levels of certain vitamins etc. (I've no particular dispute with this but wonder if, assuming the deficit is minor couldn't it be remedied with dietary changes or if it's more serious perhaps a 'once-a-day' multivitamin tablet mightn't be enough... also some deficiencies could even be because of a problem in absorption from the intestine and I don't think a tablet's going to help much there).

The FAQ is also very good, highlighting that advice should be sought from healthcare professionals and that Diabetone is "not a treatment for diabetes or metabolic control, but intended to help maintain overall health and wellbeing." This is based on research which suggests "that a multinutrient supplement [Diabetone] may [help] enhance wellbeing" and there's some vague stuff about it being "important for people with diabetes to maintain healthy insulin metabolism and research shows that certain nutrients can help to maintain normal, healthy glucose metabolism."

Only one reference ("Enhanced Wellbeing of Adults with Type 2 Diabetes following Multi-Vitamin and Mineral Supplementation") is cited, however no link is given to the original article. Google's very helpful for this sort of thing though.

Assuming that's the right paper, it was published in 2007, in 'Integrative Medicine Insights' which I hadn't heard of (the word Diabetone does not feature in PubMed, although apparently any of the journal's NIH funded articles would be indexed in PubMed) - here's an abstract and the full PDF is also linked below.

The research article itself is a pilot study, of 29 subjects with Type 2 diabetes who had fairly good baseline levels of blood glucose and blood pressure. The main things looked at were to see if Diabetone has any effect on the sorts of blood parameters that are important in diabetes (including fasting glucose levels, HbA1c and lipids) which it apparently doesn't.

"In our pilot study, a multinutrient supplement failed to significantly improve the glycemic and lipemic profile of patients with type 2 diabetes with relatively good baseline glycemic and blood pressure control. In most studies which have demonstrated such improvements in diabetes, nutrients were administered at higher doses than in our study."

The secondary outcome was wellbeing, as assessed by the wellbeing questionnaire W-BQ 22.

The conclusion, adapted on the website is "Findings from this pilot study suggest that a multinutrient supplement may enhance the wellbeing of diabetic patients, even in the absence of a significant improvement in clinical parameters."

Well OK it *might*... but I think drawing this conclusion about the pills based on a pilot study is a little premature.

More information on getting a varied diet can be found at the website of the Food Standards Agency (see the menu on the left hand side).

Reference
Marakis, G, Walker, AF., Simpson, HCR, Byng, M and Robinson PA (2007) Enhanced wellbeing of adults with Type 2 diabetes following multi-vitamin and mineral supplementation for three months in a randomised, double-blind, cross-over pilot study. Integrative Medicine Insights, 2: 7-14. Download PDF

PubMed Diabetone hits - 0
Mentions of Diabetone in ClinicalTrials.gov - 0
Mentions of Diabetone in Controlled-trials.com - 0

Always get medical advice from medically qualified people, and not me :)

Thursday, 4 March 2010

Thinking about document management as well as content management and web development software

As part of my new role in the UCL Interaction Centre I'm working with colleagues there to develop a website for the newly begun CHI+MED project. Our current site is really just a placeholder but it has some basic information on what the project's about http://www.chi-med.ac.uk

It's an important project looking at ways of making medical devices safer by understanding more about how people use them in the real world (also from understanding how they use them in controlled settings).

We're thinking about ways in which we can share documents, both with the public (which can include healthcare professionals, patients, members of the general public, device designers, people who buy the devices for the NHS, other researchers in the field) as well as more internally with people working on the project directly (eg in-progress documents or even sensitive reports).

Possibly we want an intranet and an extranet (assuming I understand the terms correctly - intranet means only CHI+MEDers can access what's there, extranet is open to the public - and it should be possible to move draft docs from the intra- to extranet once ready).

It's possible that the website itself will be 'rendered' in Dreamweaver. UCL - where I am based - uses Silva which is an open source CMS, to develop its websites, however as our project is multi-site with research taking place in Swansea, City and QMUL we don't want to use something with a UCL 'look' to it, so we're looking at other options.

If the website is Dreamwoven then this may determine the types of Document Management Systems we can use, that will mesh well. Or we may have to look at other web software or Content Management Systems.

Wondering where I can get a better handle on this? Although I have found the pages on Wikipedia telling me what CMS and DMS mean and the types of software very interesting - but I don't know much about how all these things can slot together.

Content management system | List of content management systems
Document management system|
Adobe Dreamweaver (a web development application)

So many things on the web ;-)
http://webforumz.com/how-is-this-done/67517-simple-cms-and-dreamweaver.htm