A Review of Nutritional Tracking Mobile Applications for Diabetes Patient Use.

Diabetes, a prevalent disease in the United States, is greatly impacted by lifestyle choices, notably nutrition. The goal of this research was to determine which of the nutritional tracking applications (apps) available for Apple (Cupertino, CA) iOS, Android® (Google, Mountain View, CA), and Windows (Microsoft, Redmond, WA) platforms should be a first recommendation to diabetes patients searching for a smartphone app to aid in dietary logging and, for some apps, other varying lifestyle and health data. This project did so by identifying the smartphone apps available on the iTunes® (Apple), Google Play, and Microsoft stores that have nutritional tracking capabilities and are of potential benefit to a patient with diabetes based on certain criteria. Each of the individual apps was then evaluated to determine which would be of most benefit to a diabetes patient. The apps were assessed based on several parameters, such as their food databases, logging options, additional tracking options, interoperability with other devices and apps, and diabetes-specific resources. This information was then compiled and evaluated to determine which apps would be of most benefit for diabetes patients. This research provides valuable information for both patients and healthcare providers because the results of this study can be used as a reference for practitioners wishing to make app recommendations for diabetes patients who are implementing lifestyle change as an aspect of therapy.

Effects of a medication assistance program on health outcomes in patients with type 2 diabetes mellitus.

PURPOSE: The effects of a clinic-based medication assistance program (MAP) on the health outcomes and medication use of patients with type 2 diabetes mellitus were studied. METHODS: In this retrospective analysis, data from the University of Arkansas for Medical Sciences pharmacy-managed MAP and outpatient pharmacy databases were collected for adult patients with type 2 diabetes mellitus who were monitored in the university's internal medicine clinic one year before and after enrollment in the MAP. Data on patient demographics, medication use, and disease indicators (glycosylated hemoglobin [HbA(1c)], high-density-lipoprotein [HDL] cholesterol, low-density-lipoprotein [LDL] cholesterol, total cholesterol, triglyceride, and blood pressure levels) were collected for the year before enrollment and for one year after enrollment. Statistical analyses were conducted using descriptive analyses, paired t tests, and the Wilcoxon signed rank test. RESULTS: Of the 401 patients enrolled in the internal medicine clinic who were enrolled in the MAP, sufficient data were available for 52 patients, of whom 73% were women, 50% were African American, and 48% were white. Their mean age was 59 years. All were self-paying customers, with 67.3% receiving Medicare benefits. Patients received more prescription medications (p < 0.001) and antihyperglycemic medications (p = 0.001) after enrollment in the program. Mean HbA(1c) and LDL cholesterol levels decreased significantly after enrollment (p < 0.001 for both). Mean HDL cholesterol levels and systolic and diastolic blood pressure measurements did not change significantly. CONCLUSION: A clinic-based MAP managing the use of pharmaceutical manufacturers' drug assistance programs increased indigent patients' access to antihyperglycemic medications and improved patients' clinical outcomes.

Risk of adverse cardiovascular outcomes and all-cause mortality associated with concomitant use of clopidogrel and proton pump inhibitors in elderly patients.

OBJECTIVE: To examine the effect of concomitant use of clopidogrel and PPIs in a national sample of elderly Medicare beneficiaries (age ≥65 years). METHODS: A nested case-control design was employed. A cohort of Medicare beneficiaries who initiated clopidogrel and did not have any gap of ≥30 days between clopidogrel fills between July 1, 2006 and December 31, 2008 was identified from a 5% national sample of Medicare claims data. Within this cohort, cases (beneficiaries who experienced any major cardiovascular event [MCE] [acute myocardial infarction, stroke, coronary artery bypass graft, or percutaneous coronary intervention] or all-cause mortality) and controls (beneficiaries who did not experience any MCE or all-cause mortality) were identified from inpatient and outpatient claims. Cases and controls were matched on age and the time to first clopidogrel fill. Conditional logistic regression was performed on the matched sample to evaluate the association between concomitant use of clopidogrel and PPIs and adverse health outcomes (MCEs and all-cause mortality). RESULTS: A total of 43,159 clopidogrel users were identified. Among them, 15,415 (35.7%) received clopidogrel and a PPI concomitantly at any time during the study period, 3502 (8.1%) experienced a MCE, 7306 (17.1%) died, and a total of 9908 (22.8%) experienced the primary composite outcome (any MCE or all-cause mortality) during follow-up. The odds ratio (OR) for the primary composite outcome was 1.26 (95% confidence interval [CI]: 1.18-1.35). Secondary analyses indicated that elderly patients using clopidogrel and a PPI concomitantly were more likely to experience all-cause mortality (OR: 1.40; 95% CI: 1.29-1.53) as compared to those receiving clopidogrel only, but not MCEs (OR: 1.06; 95% CI: 0.95-1.18). CONCLUSIONS: Concomitant use of clopidogrel and PPIs was associated with a slightly increased risk of all-cause mortality but not MCEs.