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Structured Abstract
Background:
While hundreds of mobile applications (apps) for diabetes self-management are commercially available, patients lack information on which apps are effective in improving diabetes-related outcomes.
Purpose:
Examine the evidence, usability, and features of commercially available mobile apps for self-management of type 1 and type 2 diabetes.
Methods:
We searched Ovid/Medline and the Cochrane Database of Systematic Reviews for systematic reviews and technology assessments, and selected five recent, high-quality systematic reviews of highest relevance. We also conducted searches online and through Ovid/Medline, CINAHL, Embase, and ClinicalTrials.gov to identify additional, recently published primary studies. We used predetermined criteria to identify eligible studies, then extracted study-level data. We conducted quality assessments, extracted technical specifications and costs, and evaluated the usability of each app.
Findings:
We identified 15 studies/analyses evaluating 11 unique apps: six apps for type 1 diabetes and five for type 2 diabetes. Two apps had multiple tiers of access (free and paid), which resulted in the evaluation of features of 13 apps. Common features of apps include the ability to track blood glucose, HbA1c, medications, physical activity, and weight. Studies were 2–12 months long. For type 1 diabetes, patients had clinically significant improvement in HbA1c if they used either of two apps and statistically significant improvement using one additional app. For type 2 diabetes, patients using any of three apps experienced clinical and statistical improvement in HbA1c. Patients using two apps for type 1 diabetes experienced improvements in hypoglycemic episodes. Patients did not experience improvements in quality of life, blood pressure, weight, or body mass index outcomes, regardless of the app or type of diabetes. The quality of studies was variable. Study design and presentation made it difficult to distinguish the effect of the app and the effect of additional interactions with study personnel or health care providers. Of the eight apps available for usability testing, three apps (two for type 1 and one for type 2 diabetes) were scored by researchers as “acceptable,” two apps (type 1 diabetes) as “marginal,” and three apps (one for type 1 and two for type 2 diabetes) as “not acceptable.”
Implications:
Some apps for diabetes self-management may improve outcomes in the short-term, but the effect cannot be distinguished from the concomitant effect of additional support from a health care provider. More rigorous and longer-term evaluations are needed to determine how these apps affect weight, blood pressure, quality of life, and complications of diabetes.
Contents
- Key Messages
- Preface
- Acknowledgments
- Key Informants
- Peer Reviewers
- Background
- Methods
- Findings
- Discussion
- Limited Statistical Efficacy of Commercially Available Apps
- Limited Clinical Efficacy of Commercially Available Apps
- Study Findings May Be Generalizable to Most Diabetes Patients
- Variation in Usability Scores
- Limited Evidence To Detect Patterns between Cost, Features, and Efficacy
- Short Duration of Studies
- Methodological Issues With Available Evidence
- Limitations
- Next Steps
- References
- Appendix A. Search Strategies
- Appendix B. Inclusion and Exclusion Criteria for Primary Research Studies
- Appendix C. Study Details
- Appendix D. System Usability Scale
Suggested citation:
Veazie S, Winchell K, Gilbert J, Paynter R, Ivlev I, Eden K, Nussbaum K, Weiskopf N, Guise J-M, Helfand M. Mobile Applications for Self-Management of Diabetes. Technical Brief No. 31. (Prepared by the Scientific Resource Center under Contract Nos. 290-2012-0004-C and 290-2017-00003-C.) AHRQ Publication No. 18-EHC010-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2018. Posted final reports are located on the Effective Healthcare Program search page. https://doi.org/10.23970/AHRQEPCTB31.
This report is based on research conducted by the Scientific Resource Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract Nos. 290-2012-0004-C and 290-2017-00003-C). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies may not be stated or implied.
Persons using assistive technology may not be able to fully access information in this report. For assistance contact vog.shh.qrha@cpe.
- NLM CatalogRelated NLM Catalog Entries
- Review Rapid Evidence Review of Mobile Applications for Self-management of Diabetes.[J Gen Intern Med. 2018]Review Rapid Evidence Review of Mobile Applications for Self-management of Diabetes.Veazie S, Winchell K, Gilbert J, Paynter R, Ivlev I, Eden KB, Nussbaum K, Weiskopf N, Guise JM, Helfand M. J Gen Intern Med. 2018 Jul; 33(7):1167-1176. Epub 2018 May 8.
- Review Tailored Communication Within Mobile Apps for Diabetes Self-Management: A Systematic Review.[J Med Internet Res. 2017]Review Tailored Communication Within Mobile Apps for Diabetes Self-Management: A Systematic Review.Holmen H, Wahl AK, Cvancarova Småstuen M, Ribu L. J Med Internet Res. 2017 Jun 23; 19(6):e227. Epub 2017 Jun 23.
- Review Going digital: a narrative overview of the effects, quality and utility of mobile apps in chronic disease self-management.[Aust Health Rev. 2020]Review Going digital: a narrative overview of the effects, quality and utility of mobile apps in chronic disease self-management.Scott IA, Scuffham P, Gupta D, Harch TM, Borchi J, Richards B. Aust Health Rev. 2020 Feb; 44(1):62-82.
- Review Behavioral Counseling to Promote a Healthy Lifestyle for Cardiovascular Disease Prevention in Persons With Cardiovascular Risk Factors: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2014]Review Behavioral Counseling to Promote a Healthy Lifestyle for Cardiovascular Disease Prevention in Persons With Cardiovascular Risk Factors: An Updated Systematic Evidence Review for the U.S. Preventive Services Task ForceLin JS, O'Connor EA, Evans CV, Senger CA, Rowland MG, Groom HC. 2014 Aug
- Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy.[JMIR Mhealth Uhealth. 2017]Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy.Wu Y, Yao X, Vespasiani G, Nicolucci A, Dong Y, Kwong J, Li L, Sun X, Tian H, Li S. JMIR Mhealth Uhealth. 2017 Mar 14; 5(3):e35. Epub 2017 Mar 14.
- Mobile Applications for Self-Management of DiabetesMobile Applications for Self-Management of Diabetes
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