Posts made in September, 2012

The Diabetes App Challenge: Built by and for Young People With Diabetes

Posted by on Sep 13, 2012 in News | 0 comments

An ambitious new study in the UK, dubbed The Diabetes App Challenge – being lead by Plymouth University Professor Ray Jones and Peninsula Medical School’s Jon Pinkney, is attempting to give young people with diabetes an opportunity to develop mobile and desktop applications for other young people who share the condition; apps made for young patients, developed exclusively by young patients.

Set up as a national competition in the UK, the challenge has been underway for several months now. With the entry deadline fast approaching, we jumped when the opportunity came up to speak with Professor Jones to find out how the study was progressing.

Thanks Professor Jones for taking time to speak with us. Can you describe how the idea for The Diabetes App Challenge originated?

As with many ideas it did not just come from one source. In the English NHS (National Health Services) there is a system of gathering research ideas from the public and professionals through organisations called CLARHCs. Somebody had suggested to our local CLARHC that some form of pre-clinic checklist for people with diabetes would improve consultations. A small group was set up to look at this and a decision was soon made that exploring this for adults and for you those in the ‘transition years’ needed a different approach, with the latter probably taking some online approach. Professor Jon Pinkney, led on this latter group and he invited me to help given my background in e-health research and having recently completed an online study with young people who self harm. So we knew we wanted to develop an app of some sort, but it was clear to me that any such development needs – at the very least – a lot of involvement from the target users. It was also clear that if the research question is ‘can an app improve the consultation?’ it may depend very much on the actual app (is it easy to use, does it do what people want etc). My son is a graphic design student and with friends had been submitting a number of pieces of work to national competitions, so the obvious way to take the diabetes app development forward was to make it a national competition from which we would offer a range of apps to other young people with diabetes to choose the one they want.

You’ve mentioned that many diabetes patients, particularly those who are young, sometimes feel like their concerns aren’t being heard when they visit a diabetes clinic. How do you think  technology can solve this problem?

We hope that they will be able to use the app, maybe to produce a list of things they want to talk about, maybe getting some ideas through discussion online beforehand of what/how to ask the things they want to ask of their doctor. So – in the jargon – we are trying to empower the young diabetics – to take a bit more control in the consultation. The clinician they see may also find it useful to see that list, or hear those prompts. Just as a bit of background, there had been a large multicenter study in the UK recently which had tried to improve consultation for children (younger age group than we are looking at) through ‘training’ the diabetes doctors in ‘motivational interviewing’. That project has not had much success. We are hoping that with the use of mobile/internet technologies, we will get the enthusiasm from young people to use it and so to ‘engage’ more in their consultations.

For the study you’re looking for applicants that A) have diabetes and B) also have the skillset required to build an app. How has the response been thus far?

Well, we are building teams. We did do a pilot study before this current project – a digital arts student at Plymouth University, Sarah Youen, who herself has diabetes developed a website called You+Your Diabetes which allows young people with diabetes to develop a checklist. So there ARE people who will have both digital skills and have diabetes. However, we are working on the basis that it is teams that will submit. So each team needs the skillset, and we’ve been ‘match making’ computer science students and others who want to take part with young people with diabetes. We have had a good deal of interest – so far we have had about 50 people show interest and (this is rather fluid as teams form and reform) makes up about 10-15 teams. Our job has been to put people in touch with others, and try to support the process of getting and keeping teams together.

Aside from the benefit of getting young people to engage with technology and problem solving, what are you hoping to demonstrate by the end of the study?

We are hoping to demonstrate that (i) it is feasible to engage young people through a competition to develop apps that will be used by young people with diabetes (YPD). (ii) that YPD will use apps for their next consultation and that they are prepared to complete questionnaires before and after taking part in the study. (This is the next stage of our study – we will recruit 200 YPD to choose and use an app). We will also discuss with both developers and YPD users whether the outcome measures we propose are the right ones.

This all – we hope – leads on to a larger follow up study in which through a randomised controlled trial we will assess the effectiveness of an app on improving consultations for YPD. But – if successful – we also think it provides a useful model for the development of apps to improve health and health services.


Entry for The Diabetes App Challenge runs from now until October 14
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Physical Activity on Bone Health

Posted by on Sep 11, 2012 in News | 0 comments

Physical activity plays a major role in fighting obesity and management of chronic conditions such as heart disease, diabetes, high blood pressure, and high cholesterol. Exercise or physical activity helps children build bones and strengthen muscles and joints. In older adults, physical activity improves strength and mobility, which in turn reduces falls and fall-related injuries.

In a recent study on premenopausal women, researchers found an increase in bone formation markers and high serum IGF-1 (positive effector on bones) in women who have more than 120 minutes of physical activity per week than sedentary women. One study was conducted on women over 65 years of age and participants were randomly placed into either the exercise group or control group. At the end of the 18 months study, researchers measured bone mineral density on both groups and found that women in the exercise group had higher bone mineral density than the control group. Bone mineral density tells us the amount of calcium and minerals in your bones. Lower bone mineral density indicates higher risk for osteoporosis.

Furthermore, physical activity is an important part of the treatment and prevention of osteoporosis. In osteoporosis, weight bearing, and strengthening activities are crucial and effective. A physical therapist can help you design an exercise program that’s right for you. Any amount of physical activity helps you stay healthy and can have a positive impact on bone health.


Contributed by Patricia Hsiao M.D.
Sources: Medscape, The National Center for Biotechnology Information
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The Safest Oral Drug for Type 2 Diabetes

Posted by on Sep 10, 2012 in News | 0 comments

Unsure of what the safest drug is for type 2 diabetes? New research says that diabetic patients who are treated with sulfonylurea drugs other than metformin have a significantly higher mortality.

Glipizide, glimepiride, and glyburide were recently compared to metformin in patients with coronary artery disease. The safest drug was metformin and all experts agree that today it should be the first line drug prescribed for type 2 diabetics.

This research is relevant because diabetes is on the increase and sulfonylureas are widely prescribed to many diabetics. Until recently, these drugs were all felt to be similar in effectiveness and safety, but now this research reveals otherwise. Metformin is now available as a generic, is very affordable, and is an excellent drug for blood glucose control. However, in patients with coronary disease, glimepiride may be the preferred drug.

Overall, glipizide and glimepiride are preferred over glyburide, but metformin should be the drug of choice in most type 2 diabetics.

Even though sulfonylureas have been available for many years, it appears that we still don’t know much about them. It’s important for consumers not to stop taking their medications and to speak to their physicians before doing so.


Contributed by Dr. Steven Bhimji, M.D.
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Uncovering the Relation Between Purine Intake and Gout

Posted by on Sep 6, 2012 in News | 1 comment

Gout is one of the most common types of arthritis that affects a single joint at first. Acute gout is defined as a sudden, severe attack of pain, swelling and inflammation at a joint (particularly the big toe). Gout occurs when you have high uric acid in your blood, which can then form into crystals. Urate crystals often get deposited in the joints, kidneys, or urinary tract. Uric acid comes from the breakdown of certain foods we eat. In some people, high uric acid is the result of overproduction of uric acid by the body. In others, it’s due to the fact that the body can’t get rid of uric acid efficiently. Keep in mind that not everyone with high uric acid has gout symptoms.

Gout and hyperuricemia are found to be related to obesity, diabetes, high blood pressure, high cholesterol, and alcohol abuse. Both have been treated with medications, diet, and lifestyle changes. Studies have shown that obesity increases the risk of developing gout, therefore maintaining a healthy weight and diet are important factors for prevention. In the past a very restricted purine diet was recommended for people with gout. We get purine from both animal and plant products. High purine is often found in red meat, anchovies, trout, sardines, herring, mussels, scallop, bacon, and organ meats. Vegetables such as spinach, legumes (dried beans and peas), asparagus, and mushrooms are also rich in purine, along with alcoholic drinks such as beer, hard liquors (gin and vodka), and spirits. You may also find high purine content in foods made with high fructose corn syrup, especially non-diet sodas.

Recent studies

A clinical study, conducted over the span of 12 years, showed that a high amount of meat and seafood consumption increases your risk for gout, while moderate consumption of high purine-rich vegetables or protein doesn’t increase your risk for gout. Researchers also found that high dairy consumption seems to have a decreased risk of gout. Furthermore, another study was done on people with gout, where data was collected during the gout attack. It showed that purine-rich foods increase the risk of repeated gout attacks by five times. Researchers concluded that cutting down the amount of purine-rich foods in your diet especially from animal sources may help reduce gout attack.

Current recommendations for gout diet

  • Limit your daily meat and fish intake to the size of your fist (about 4-6 ounces)
  • Eat foods with complex carbohydrates particularly whole grains, brown rice and oats
  • Eat low-fat or fat free dairy products
  • Avoid beverages that are sweetened with high fructose corn syrup
  • Keep yourself hydrated with plenty of fluids daily (8-12 glasses of water a day is recommended)
  • It’s fine to drink one or two cups of coffee a day
  • Avoid beers, hard liquors and spirits
  • Moderate amount of wine is OK. For women, it should be no more than one glass per day and for men, it should be no more than two glasses per day

Contributed by Patricia Hsiao M.D.
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Can Chocolate Lower Blood Pressure?

Posted by on Sep 5, 2012 in News | 0 comments

In the last 10 years, many studies have reported that dark chocolate can lower blood pressure. The key ingredients in cocoa that provides this beneficial effect are the flavonoids. The belief is that the flavonoids stimulate production of nitric oxide, which relaxes the blood vessels and lowers the blood pressure.

However, the blood pressure lowering effect of dark chocolate is minor. At most, the blood pressure only drops by a few mm of Hg. In addition, all the studies which report these findings have been of short term.

For diabetics who want the “easy out” to lower blood pressure, dark chocolate is definitely not recommended. Cocoa isn’t the best method of lowering blood pressure due to the presence of sugar and fat. Chocolate may taste great and lower blood pressure, but it also adds many calories.

Cocoa isn’t the only food that contains flavonoids. Other foods that are also rich in flavonoids are apples, beans, blackberries, and apricots. These foods have the same health benefits of cocoa, but don’t add calories.

For diabetics, it’s important to adhere to the blood pressure medications and not suddenly jump to whatever is reported in the media. To further help lower blood pressure, exercise and not smoking are highly recommended.

Eating chocolate to lower blood pressure is for people who have too many excuses and care little about their health or weight.


Contributed by Dr. Steven Bhimji, M.D.
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