Background Optimal management of chronic diseases, such as type 2 diabetes (T2D) and obesity, requires patient-provider communication and proactive self-management from the patient. Mobile apps could be an effective strategy for improving patient-provider communication and provide resources for self-management to patients themselves. Objective The objective of this paper is to describe the development of a mobile tool for patients with T2D and obesity that utilizes an integrative approach to facilitate patient-centered app development, with patient and physician interfaces. Our implementation strategy focused on the building of a multidisciplinary team to create a user-friendly and evidence-based app, to be used by patients in a home setting or at the point-of-care. Methods We present the iterative design, development, and testing of DiaFit, an app designed to improve the self-management of T2D and obesity, using an adapted Agile approach to software implementation. The production team consisted of experts in mobile health, nutrition sciences, and obesity; software engineers; and clinicians. Additionally, the team included citizen scientists and clinicians who acted as the de facto software clients for DiaFit and therefore interacted with the production team throughout the entire app creation, from design to testing. Results DiaFit (version 1.0) is an open-source, inclusive iOS app that incorporates nutrition data, physical activity data, and medication and glucose values, as well as patient-reported outcomes. DiaFit supports the uploading of data from sensory devices via Bluetooth for physical activity (iOS step counts, FitBit, Apple watch) and glucose monitoring (iHealth glucose meter). The app provides summary statistics and graphics for step counts, dietary information, and glucose values that can be used by patients and their providers to make informed health decisions. The DiaFit iOS app was developed in Swift (version 2.2) with a Web back-end deployed on the Health Insurance Portability and Accountability Act compliant-ready Amazon Web Services cloud computing platform. DiaFit is publicly available on GitHub to the diabetes community at large, under the GNU General Public License agreement. Conclusions Given the proliferation of health-related apps available to health consumers, it is essential to ensure that apps are evidence-based and user-oriented, with specific health conditions in mind. To this end, we have used a software development approach focusing on community and clinical engagement to create DiaFit, an app that assists patients with T2D and obesity to better manage their health through active communication with their providers and proactive self-management of their diseases.

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Objective: To evaluate the association between dietary GL and systolic (SBP) and diastolic blood pressure (DBP) during healthy pregnancy. Methods: Prospective cohort of 155 healthy pregnant women followed at 6‐13th, 20‐26th and 30‐36th gestational weeks. Dietary GL was calculated from glycemic index, carbohydrate content, and frequency intake of selected foods, obtained from food frequency questionnaire applied in the 3rd trimester having the whole pregnancy as the time frame. SBP and DBP throughout pregnancy were the outcomes. Statistical analysis comprised multiple longitudinal linear mixed‐effect models adjusted for obstetric, socioeconomic, dietetic, and biomarker variables. Results: Mean SBP was 109.7, 107.9, and 111.3 (mmHg) and DBP was 66.6, 64.3, and 67.2 (mmHg) for the 1st, 2sd and 3rd trimester, respectively, and didn’t varied according to tertile of GL in the 3rd trimester (p>0.05). GL was not associated with SBP in the multiple model (β=0.237; 95%CI=‐0.16‐0.64; p=0.245). GL was positively associated with DBP (β=0.387; 95%CI=0.08‐0.69; p=0.015) after adjusting for confounders such as per‐capita family income, skin color, BMI, and calories. Conclusion: Dietary GL was positively associated with DBP changes during pregnancy. Grant Funding Source: Supported by: FAPERJ, CNPq, CAPES

BackgroundSpending on biological agents has risen dramatically in Spanish hospitals due to the drugs’ high cost and the increased prevalence of spondyloarthritis.ObjectivesTo calculate and compare the annual cost per patient with spondyloarthritis and for each biological drug according to clinical practice from 2009 to 2016 and to analyse the factors that influence consumer pricing, such as biological therapy optimisation (by monitoring drug and anti-drug antibody serum levels), the use of tumour necrosis factor inhibitor biosimilars, and drug discounts, refunds, and rebates.MethodsWe conducted a retrospective observational study that analysed patient demographic parameters, disease activity, and annual cost per patient and per drug and determined the economic factors that affected on consumer pricing.ResultsA total of 129, 215, and 224 patients were treated in 2009, 2013, and 2016, respectively; 77 (59.69%), 133 (61.86%) and 139 (62.05%), respectively, were men aged 46.04 (±12.57), 47.76 (±12.35) and 48.27 (±13.49) years, respectively. Nonstatistically significant differences were observed.The annual cost per patient decreased during the study period (from €11.604 in 2009, €8.513 to €7.464 in 2016). There was an increase in the number of marketed biological drugs and in the total savings per drug, with discounts and bonus units in 2016 reaching 12%–18% for etanercept, adalimumab, certolizumab, and golimumab and up to 25% for the recently released secukinumab, while rebates for biosimilar infliximab reached 69% in 2016. Biological therapy optimisation reached 47.5% in 2016, which resulted in cost savings of 23.89%, in addition to the savings from refunds and rebates (11.06%) in 2016.ConclusionsThe resulting treatments after the rebates, invoice discounts, and optimizations were more cost-effective, leading to a significant decrease in the annual cost per patient and an overall reduction in expenditure for these drugs.References[1] Guía de Práctica Clínica para el Tratamiento de la Espondiloartritis Axial y la Artritis Psoriásica. Available at https://www.ser.es/wp-content/uploads/2016/04/GPC_-Tratamiento_EspAax_APs_DEF.pdf[2] Informe técnico ANTI-TNF – reumatologia.pdf [Internet]. [cited June21,2017]. Available at http://sescam.castillalamancha.es/sites/sescam.castillalamancha.es/files/documentos/farmacia/reumatologia.pdf[3] Real Decreto-ley 4/2010, de 26 de marzo, de racionalización del gasto farmacéutico con cargo al Sistema Nacional de Salud. BOE.es[4] Pascual-Salcedo D, Plasencia C, Jurado T, Valle LG del, Sabina P, Diego C, et al. Dose-Tapering Of TNF Inhibitors in Daily Rheumatology Practice Enables the Maintenance of Clinical Efficacy While Improving Cost-Effectiveness. J Pharmacovigil;3(4).[5] Guidelines on evaluation of similar biotherapeutic products (SBPs). Available at: http://www.who.int/biologicals/publications/trs/areas/biological_therapeutics/Guidelines_Biotherapeutic_products_FINAL_HK_IK_12_June.pdfAcknowledgementsWe would like to thank the staff in the Departments of Pharmacy and Rheumatology. In...