Efficacy of Mobile Apps to Support the Care of Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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Abstract

Background

Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health apps.

Objective

The aim of our study was to evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist DM patients in treatment.

Methods

We conducted searches in the electronic databases MEDLINE (Pubmed), Cochrane Register of Controlled Trials (CENTRAL), and LILACS (Latin American and Caribbean Health Sciences Literature), including manual search in references of publications that included systematic reviews, specialized journals, and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, patients with DM, and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager software version 5.3.

Results

The literature search identified 1236 publications. Of these, 13 studies were included that evaluated 1263 patients. In 6 RCTs, there were a statistical significant reduction ( P<.05) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (mean difference, MD −0.44; CI: −0.59 to −0.29; P<.001; I²=32%).The evaluation favored the treatment in patients who used apps without significant heterogeneity.

Conclusions

The use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care by contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly by reducing their fear of not knowing how to deal with potential hypoglycemic episodes that may occur.

Related collections

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To assess the effect of mobile phone intervention on glycaemic control in diabetes self-management. We searched three electronic databases (PubMed, EMBASE and Cochrane Library) using the following terms: diabetes or diabetes mellitus and mobile phone or cellular phone, or text message. We also manually searched reference lists of relevant papers to identify additional studies. Clinical studies that used mobile phone intervention and reported changes in glycosylated haemoglobin (HbA(1c) ) values in patients with diabetes were reviewed. The study design, intervention methods, sample size and clinical outcomes were extracted from each trial. The results of the HbA(1c) change in the trials were pooled using meta-analysis methods. A total of 22 trials were selected for the review. Meta-analysis among 1657 participants showed that mobile phone interventions for diabetes self-management reduced HbA(1c) values by a mean of 0.5% [6 mmol/mol; 95% confidence interval, 0.3-0.7% (4-8 mmol/mol)] over a median of 6 months follow-up duration. In subgroup analysis, 11 studies among Type 2 diabetes patients reported significantly greater reduction in HbA(1c) than studies among Type 1 diabetes patients [0.8 (9 mmol/mol) vs. 0.3% (3 mmol/mol); P=0.02]. The effect of mobile phone intervention did not significantly differ by other participant characteristics or intervention strategies. Results pooled from the included trials provided strong evidence that mobile phone intervention led to statistically significant improvement in glycaemic control and self-management in diabetes care, especially for Type 2 diabetes patients. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

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To introduce guidelines for the conduct, reporting, and critical appraisal of meta-analyses evaluating diagnostic tests and to apply these guidelines to recently published meta-analyses of diagnostic tests. Based on current concepts of how to assess diagnostic tests and conduct meta-analyses. They are applied to all meta-analyses evaluating diagnostic tests published in English-language journals from January 1990 through December 1991, identified through MEDLINE searching and by experts in the field. Meta-analyses were included if at least two of three independent readers regarded their main purpose as the evaluation of diagnostic tests against a concurrent reference standard. By three independent readers on the extent to which meta-analyses fulfilled each guideline, with consensus defined as agreement by at least two readers. The guidelines are concerned with determining the objective of the meta-analysis, identifying the relevant literature and extracting the data, estimating diagnostic accuracy, and identifying the extent to which variability is explained by study design characteristics and characteristics of the patients and diagnostic test. In general, the guidelines were only partially fulfilled. Meta-analysis is potentially important in the assessment of diagnostic tests. Those reading meta-analyses evaluating diagnostic tests should critically appraise them; those doing meta-analyses should apply recently developed methods. The conduct and reporting of primary studies on which meta-analyses are based require improvement.

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Author and article information

Contributors

Bráulio Cezar Bonoto:

Post Graduate Program in Medicines and Pharmaceutical AssistanceDepartment of Social PharmacyFederal University of Minas GeraisAv Presidente Antônio Carlos, 6627Campus PampulhaBelo Horizonte, 31270-901Brazil55 31 98722 947755 31 98722 9477brauliofarma@yahoo.com.br

ORCID: http://orcid.org/0000-0001-7514-2407

Journal

Journal ID (nlm-ta): JMIR Mhealth Uhealth

Journal ID (iso-abbrev): JMIR Mhealth Uhealth

Journal ID (publisher-id): JMU

Title: JMIR mHealth and uHealth

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2291-5222

Publication date Collection: March 2017

Publication date (Electronic): 01 March 2017

Volume: 5

Issue: 3

Electronic Location Identifier: e4

Affiliations

[1] ¹Post Graduate Program in Medicines and Pharmaceutical Assistance Department of Social Pharmacy Federal University of Minas Gerais Belo HorizonteBrazil

[2] ²Institute of Biological Sciences and Health Faculty of Odontology Pontifícia Universidade Católica de Minas Gerais Belo HorizonteBrazil

[3] ³SUS Collaborating Centre for Technology Assessment and Excellence in Health Department of Social Pharmacy Federal University of Minas Gerais Belo HorizonteBrazil

[4] ⁴Post Graduate Program in Public Health Department Preventive and Social Medicine Federal University of Minas Gerais Belo HorizonteBrazil

[5] ⁵Institute of Pharmacy and Biomedical Sciences University of Strathclyde Glasgow GlasgowUnited Kingdom

[6] ⁶Division of Clinical Pharmaclogy Karolinska Institutet Karolinska University Hospital StockholmSweden

[7] ⁷Department of Clinical Medicine Faculty of Medicine Federal University of Minas Gerais Belo HorizonteBrazil

Author notes

Corresponding Author: Bráulio Cezar Bonoto brauliofarma@ 123456yahoo.com.br

Author information

Bráulio Cezar Bonoto http://orcid.org/0000-0001-7514-2407

Vânia Eloisa de Araújo http://orcid.org/0000-0002-0345-8522

Isabella Piassi Godói http://orcid.org/0000-0002-0568-6625

Lívia Lovato Pires de Lemos http://orcid.org/0000-0002-8921-515X

Brian Godman http://orcid.org/0000-0001-6539-6972

Marion Bennie http://orcid.org/0000-0002-4046-629X

Leonardo Mauricio Diniz http://orcid.org/0000-0001-9651-8485

Augusto Afonso Guerra Junior http://orcid.org/0000-0001-5256-0577

Article

Publisher ID: v5i3e4

DOI: 10.2196/mhealth.6309

PMC ID: 5352856

PubMed ID: 28249834

SO-VID: 8cf76b6b-4d54-4ff1-8ca7-dbe68f3cbe2e

Copyright © ©Bráulio Cezar Bonoto, Vânia Eloisa de Araújo, Isabella Piassi Godói, Lívia Lovato Pires de Lemos, Brian Godman, Marion Bennie, Leonardo Mauricio Diniz, Augusto Afonso Guerra Junior. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 01.03.2017.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 4 July 2016

Date revision requested : 18 August 2016

Date revision received : 28 September 2016

Date accepted : 23 October 2016

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