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Diabetes Update: Gila Monsters

Number 36; April 30, 2002

By David Mendosa

This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written. I list and link most of these on my Diabetes Directory at

From time to time Diabetes Update may also include links to other Web pages of special interest.

My most recent contribution is:

on April 30, 2002

  1. The Monster Drug

    Gila Monster
    The Beautiful Gila Monster
    The most fascinating drug discovery story that I have ever run across is Dr. John Eng's research on gila monster venom. He synthesized it and gave it the name exendin-4. It sharply reduces blood glucose and somewhat reduces appetite. When his employer declined to patent it, Dr. Eng bet that it would be important. Eventually he sold the rights to the drug to Amylin Pharmaceuticals, which is developing it as AC2993. It is now in Phase 3 clinical trials. A few days ago I had the opportunity to talk with Dr. Eng for more than an hour and get the full story. The URL is

  2. Rating Criteria for Health Sites
    I developed these criteria to rate Web sites for several consulting clients. I hope that some of you can make good use of this work either personally or professionally.

    • Credibility:

      Is the site trustworthy? It must satisfy the HON Code of Conduct. Specifically this includes attribution (dating when each page was last modified) and transparency of authorship (and contact addresses).

      A. Does the site clearly state the ownership/sponsorship?

      B. Does it list a medical advisory board, editorial board, or committee that had input into or oversight over the health content?

      C. Does it provide detailed biographical information for these people?

      D. Does it have contact information including phone, email, and physical address?

      E. Is the information current? Are the site's pages dated and are those dates recent?

      F. Does the site have a privacy statement?

    • Content:

      A. Does the site have comprehensive product information, including full prescribing information in an easy-to-read format? Does it avoid presenting large blocks of text that would be more suited to a print publication?

      B. Is the site readable? How well can visitors comprehend it? For an excellent discussion of readability see Sandra Smith's "Readability Testing Health Information".

      Almost all sites overestimate the reading comprehension of their typical reader. A study of English-speaking diabetes patients reported in a journal of the British Diabetic Association in 1993 found that only 19 percent could understand information written at the 11th grade level. It increased only slightly to 21 percent at the 9th grade level, but jumped to 60 percent at the 6th grade level (JE Overland et al., "Low Literacy: a problem in diabetes education" Diabetic Medicine 1993 Nov; 10(9):847-50).

      I used standard measures of readability, the Flesch Reading Ease score and the Flesch-Kincaid Grade Level score. Microsoft Word can calculate these scores automatically. After Microsoft Word completes a grammar check, you can have it display readability statistics. This index computes readability based on the average number of syllables per word and the average number of words per sentence.

      The Flesch Reading Ease score rates text on a 100-point scale. The higher the score, the easier it is to understand the document. For most standard documents, it's appropriate to aim for a score of 60 to 70.

      The Flesch-Kincaid Grade Level score rates text on a U.S. grade-school level. For example, a score of 8.0 means that an eighth grader can understand the document. For most standard documents, it is appropriate to aim for a score of 6.0 to 8.0.

    • Design:

      A. How easy is it for visitors to navigate the site? Is it logically organized?

      (1) Does the site use the Web industry standard of underlining text links?

      (2) Do visited links change color? Technically, the default standard is to code LINK (an unvisited link) as red, VLINK (a visited link) as purple, and ALINK (the active link) as red.

      B. Does the site have an internal search capability?

      C. Does the site load reasonably quickly with a 28.8 KBPS modem? Added later: "What really drives people to return to a Web site-flashy design or fast access? Speed rules, say researchers at Jupiter Media Metrix. According to Jupiter's study, 40 percent of Web surfers say they'll visit a Web site more often if pages load quickly, but only 20 percent will go back because of a rich media experience.

      "Before beginning any site development, companies should survey their users, because every site's users are different," says Jupiter analyst Cormac Foster. Foster emphasizes that site operators "can address their user experience issues at a low cost, without having to invest in new technologies."

      The most cost-effective approach, says Foster, is to avoid "risky, glamorous Web enhancements."

      Source: "Dash, Not Flash" by Baria M. Abdur-Razzaq, PC Magazine, Nov. 13, 2001.

      D. Does the site have a site map?

      E. Is it relatively free of typographical and HTML errors?

      F. Does the site make good use of attractive graphics, used consistently from page to page?

      G. Are the design elements (colors, images, slogans) consistent with other media that the sponsoring company uses? In other words, is there consistent branding?

      H. Does the site avoid annoying pop-ups and animated banners?

      I. Is the site accessible to individuals with disabilities? Because diabetes causes many disabilities, this is an important consideration for diabetes-related sites. It's easy to evaluate this accessibility with an online tool called "Bobby". CAST (founded as the Center for Applied Special Technology) provides it free to identify and repair significant barriers to access by individuals with disabilities.

    • Interactivity:

      A. Does the site provide a feedback form and/or email address labeled for feedback?

      B. Does the site provide a means for exchange of information among users? These are known variously as forums, conferences, discussion groups, message boards, or bulletin boards.

      C. Does the site provide interactive tools, such as a blood glucose tracker?

      D. Does the site provide any other reason for visitors to return often, such as news?

      E. Does the site have a mailing list or update feature to keep in touch with visitors to the site?

    • Links:

      A. Are the site's links to external Web pages credible sources?

      B. Does it have has no or few dead links?

      I checked each of these sites with Linkbot, a Web developers tool that checks for dead links and many other problems. Eric Rumsey of the Hardin Library for the Health Sciences at the University of Iowa has done more than anyone to encourage Web developers to kill dead links. The Hardin MetaDirectory of Internet Health Sources (AKA Hardin MD) is a list of lists of medical resources that he checks to see that they are being well maintained (it gives my "On-line Diabetes Resources" a "Clean Bill of Health"


    on April 15, 2002
  1. The GlucoWatch Comes to Market
    After years of waiting, Cygnus Inc. finally began selling the GlucoWatch on April 15. If you want one, you better be rich or have exceptional health insurance. This non-invasive, automatic glucose meter is expensive! The watch itself sells for $595 and its AutoSensors (the disposable component that attaches to the back of the GlucoWatch and allows for glucose monitoring for up to 12 hours) cost about $4.35 each. That means continuous coverage for the first year of use will set you back about $3,800. See

    on April 28, 2002

  2. Alternative Medicine
    While I don't use any alternative medicines to control my diabetes, I know that many people are interested in them. A column that I wrote for the American Diabetes Association's Web site a couple of years ago reports on what I think is the best such site, AlternativeDiabetes. Now there is a positive report in the current (March-April 2002) issue of the Journal of the American Pharmaceutical Association about "Natural products used for diabetes." Karen Shapiro and her associates at the College of Pharmacy, Western University of Health Sciences, Pomona, California, look at nopal (prickly pear cactus), fenugreek, karela (bitter melon), gymnema, ginseng, tronadora, chromium, and alpha lipoic acid. "For several of these, high soluble fiber content is a contributing factor [resulting in] lower blood glucose in patients with diabetes," they conclude. Personally, I think we are all better off sticking with our standardized insulin or pills.


New Titles
A couple of weeks ago a subscriber named Joe made a great suggestion. He wrote, "You give out the date and the # of your updates. What about a title so we will know which one we want to review or read (maybe) for the first time?" Consequently, this update contained "Gila Monsters" in the title. Further, I've gone back and added a title to each of the 35 previous updates. The title doesn't cover every item. It reflects what I think is the most important or most interesting item or the one that I refer to the most often. Thanks, Joe!


I send out Diabetes Update e-mail in HTML format, which all Web browsers and most modern e-mail programs can display. HTML has live links to all the sites named in the text so that with a simple click of a mouse you can connect to the site you have just been reading about.

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