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Episode 148: Definitively vague questions with vaguely definitive answers – PART II

In episode 148, Mike and James return to the town of Questionville and attempt to answer riddles from near and far. Despite Mike having a cold, we tackle long acting insulins, exercise, multivitamins and varenecline with near Herculean-like abilities but provide answers that are much more on the mere-mortal side.

Show notes

1) Long acting insulins

CADTH report  Long-Acting Insulin Analogues for the Treatment of Diabetes Mellitus

Diabetes Care 2009;32:32-37

Adv Ther 2009;26:535-51

Tools for Practice – The long and short of long acting insulin analogues (versus NPH)

Tools For Practice – Strategies for initiating insulin in Type 2 Diabetics:  What is the optimal regimen for initiating insulin in type 2 diabetes?

2) Activity

QoL stuff

Arch Intern Med 2009;169:269-278


Can Fam Physician 2010;56:887

Exercise Improves: Sleep, osteoarthritis pain, depression, obesity, glucose, lipids, BP

Cochrane 2002;CD003404

J Gerontol A Biol Sci Med Sci 2008;63:997-1004

J Sports Med Phys Fitness 2007;47:462-7

Cochrane 2008:CD004366

Cochrane 2008:CD004376

Inactivity a bigger risk than weight

J Am Geriatr Soc 2010;58:234–241

Activity and mortality

Arch Intern Med 2007;167:2453-2460

JAMA 2003;289:2379-2386

NEJM 2002;347:716-25

JAMA 1995;273:1093-8

Circulation 2008;117: 614-622

PLOS 2008;5: e12.

More activity, better

Br J Sports Med 2008;42:238–243

NEJM 1999;341:650-8

Eur J Epidemiol 2009;24:181–192

RCT of activity vs angioplasty

Circulation 2004;109:1371-8

3) Multivitamin Evidence

A & E harmful

Can Fam Physician 2005;51:1471-2

Tools for practice #10 

Multivitamins unnecessary(among first to be stopped in polypharmacy)

JAMA 2010;304:1592-1601

Vitamin B increases mortality

BMJ 2010;341:c6273

4) Vitamin D

Vitamin D problems

JAMA 2010;303:1815-1822

Rheumatology 2007;46:1852–1857

Regular dose reduces mortality


Reduces falls

BMJ 2009;339:b3692 doi:10.1136/bmj.b3692


For fractures (yes with Ca+, unsure otherwise)


Re-evaluating the whole reference range

J Clin Endocrinol Metab 2011;96:53–58

5) Calcium evidence

Can Fam Physician 2011;57:798

6) Varenicline for smoking cessation

Cardiovascular events

CMAJ 2011;183:1359-66

Pharmacotherapy for smoking cessation

CFP 2011;57:47

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