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Veazie S, Winchell K, Gilbert J, et al. Mobile Applications for Self-Management of Diabetes [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 May. (Technical Brief, No. 31.)
Table C-1Study details for apps for type 1 diabetes
| App Name Author & Year Length of Study ROB Assessment | Participants | Intervention | Comparator | Outcome | Significant improvement in intervention vs. comparator | Outcome effect size [95% CI] & P-value | Outcome Measurement Details |
|---|---|---|---|---|---|---|---|
| Glucose Buddy Kirwan 20131 6 months Moderate quality Australia | Number: 72
Age: Mean 35.2 Diabetes severity: Duration of diabetes (years) 18.94 Mean HbA1c: 8.78% Insulin pump: 38% Key I/E criteria: Treated with multiple daily injections or insulin pump. | With Glucose Buddy, ppts manually enter BG levels, insulin dosages, other medications, diet (food item in grams), and physical activity (minutes). Ppts view data on customizable graph and information reviewed weekly by certified diabetes educator (CDE). Ppts sent minimum of one personalized text message per week by CDE. | Usual care which includes visit to primary care diabetes health care practitioner every 3 months. | HbA1C(%) | Yes (but significant differences at baseline so interpret with caution) | p < 0.001 from baseline to 9 months (6 months of intervention with 3 months follow-up) I group from 9.08 to 7.80% vs. C group from 8.47 to 8.58% | NA |
| Diabetes - related self efficacy | No | p>0.05 | Diabetes Empowerment questionnaire (DES-SF) | ||||
| Self-care behaviors | No | p>0.05 | Summary of Diabetes Self Care Activities, 6-item measured which authors included 4 items: general diet, specific diet, exercise, and glucose testing | ||||
| Quality of Life | No | p>0.05 | Diabetes Quality of Life | ||||
| Diabetes Manager Garg 20172 6 months Low quality United States | Number: 100
Age: Mean I group 38; C group 39 Diabetes severity: Duration of diabetes (years) I group 25; C group 22 Mean HbA1c (%): I group 8.0; C group 7.7 Comorbidities BMI: I group 27.1; C group 27.3 (both overweight) Key I/E criteria: Excluded ppts with history of severe hypoglycemia in last 6 months | The iBGStar system is a BG meter that attaches to an iPhone as a peripheral device. Using the iBGStar with the Diabetes Manager App, a user’s iPhone can function as a blood glucose meter. The Diabetes Manager App provides personal feedback on SMBG by allowing ppts to filter and dynamically interact with log book data, graph trends, and view statistics. Provider communicated every 7-14 days throughout study (email, text, home) All subjects (I and C groups) had similar clinic and phone visits for 3 months, with a 3-month extension, for a total of 8 required visits—a screening visit, 4 in-clinic visits, and 3 phone calls. | Self-monitoring of blood glucose with Accu-Chek Nano. Training on their use was provided at baseline and reinforced at week 1. Ppts encouraged to contact provider as needed | HbA1C(%) | Yes | −0.51 in intervention vs −0.16 in control (p=0.04) | NA |
| Hypoglycemic events | No | 21.5 ± 15.5 in intervention vs 25.5 ± 31.0 in control (p=0.48) | Not defined | ||||
| Hypoglycemia fear | No | −1.37 ± 9.9 in intervention vs −3.9 ± 12.5 in control (p=0.32) | hypoglycemia fear score | ||||
| Dbees
Drion 20153 3 months Moderate quality Netherlands | Number: 63
Age: Median 33 Diabetes severity: Duration of diabetes (years) 17 Mean HbA1c (mmol/mol): 62 Insulin pump: 66% Comorbidities retinopathy 25% nephropathy 2% neuropathy 19% Key I/E criteria: Treated with multiple daily injections, continuous subcutaneous insulin infusion, or continuous intraperitoneal insulin infusion. | Intervention was offered as an application and a personal web portal linked to application and consisted of a digital diabetes diary which could manually enter diabetes-related self-care data: blood glucose values, carbohydrate intake, medication, physical exercise, and notes into the application. | Standard paper diary | HbA1C (mmol/mol) | No | median between group differences (IQR)−2 (−6,5) | NA |
| Usability | Yes (int. only) | I group rated as 77 out of 100 | SUS | ||||
| Quality of Life | No | median between group differences (IQR):
Physical component: 0 (−1,1) Mental component: −1 (−7,5) | RAND-36 health survey | ||||
| Diabetes emotional distress | No | median between group differences (IQR): −1 (−4,2) | Problem Areas in Diabetes (PAID) questionnaire | ||||
| Diabetes Diary
Skrovseth 20154 8 weeks (1st intervention group)/10 weeks (2nd intervention group) Low quality Norway | Number: 30
Age: Mean 39.70 Diabetes severity: Mean HbA1c: 8.2% Key I/E criteria: T1DM > 1 year (insulin pumps were included) Excluded if had “severe complications attributed to their diabetes that would render participation unethical or medically challenging” | This intervention was Diabetes Diary with an additional data-driven feedback module for BG self-management, Diastat Bluetooth enabled phone connected to BG meter. Diastat included last BG measurement, last insulin recording and last carbohydrate registration. | Diabetes Diary app without the Diastat feedback module | HbA1C(%) | CND | −0.60% from baseline to 8 weeks p< 0.001 (no between group difference-in-differences reported) | NA |
| Combined hypoglycemic and hyperglycemic events* | Yes | Median out-of range (OOR) events over 2 weeks:−14.5 (95% CI−18.0 to −9.0; p< 0.001) | OOR events–combine BGs outside range 72-270 mg/dl | ||||
| Diabetes Interactive Diary Rossi 20105 6 months Moderate quality Italy | Number: 130 Age: Mean I group 35.4; mean C group 36.1 Diabetes severity: Duration of diabetes (years) I group 17.1; C group 15.8 Mean HbA1c (%): I group 8.2; C group 8.4 Insulin pump: I group 19%; C group 19% Comorbidities: retinopathy: I group 29%; C group 21% nephropathy: I group 5%; C group 3% symptomatic neuropathy: I group 9%; C group 3% lower limb complications: I group 0%; C group 3% Key I/E criteria: Multiple daily injections of short- and long-acting insulin analogs or continuous subcutaneous insulin infusion; self-monitoring BG minimum 3 times/day | The Diabetes Interactive Diary (DID) isa carbohydrate/insulin bolus calculator, an information technology device, and a telemedicine system based on the communication between a health care professional (physician or dietitian) and a participant via text messages. It supports participants in managing the CHO counting through a food atlas and in recording the self-monitoring blood glucose (SMBG) measurements. DID suggests the daily carbohydrate intake, and automatically calculates the most appropriate insulin dose to be injected at each meal. All the recorded data are sent to the physician via SMS and clinic sends personalized recommendations (insulin doses, activity) to participant’s mobile phone. | Standard education | HbA1C(%) | No | −0.4 ± 0.9 in intervention vs. −0.5 ± 1 in control (p=0.68) | NA |
| Lipids | Triglycerides:
(mg/dl)- Yes Total cholesterol (mg/dl)- No HDL (mg/dl) - No LDL(mg/dl)- No | Triglycerides:
−10.7 ± 56.1 in intervention vs −8.2 ± 43.4 in control (p=0.04) Total cholesterol: −3.6 ± 32.3 in intervention vs 2.7 ± 28.9 in control (p=0.33) HDL: 1.6 ±8.5 in intervention vs 4.8 ± 10.3 in control (p=0.14) LDL:−3.4 ± 29.1 in intervention vs 0.3 ± 27.6 in control (p=0.79) | NA | ||||
| Blood pressure (mmHg) | No | SBP: −0.8 ± 8.6 in ntervention vs −0.7 ± 11.5 in control (p=0.71) DBP:−1.3 ± 6.5in ntervention vs −1.1 ± 7.6 in control (p=0.89) | NA | ||||
| Diabetes treatment satisfaction | Yes | 3.4 ± 4.2 in intervention vs 1 ± 4 in control (p=0.04) | World Health Organization-Diabetes Treatment Satisfaction Questionnaire | ||||
| Weight (kg) | No | 0.7 ± 3.6 in intervention vs 1.5 ± 2.3 in control (p=0.22) | NA | ||||
| Quality of Life | No | Physical component score p=0.77 Mental component score: p=0.14 | SF-36 | ||||
| Severe hypoglycemic episodes | No | No episodes | Requiring assistance | ||||
| Self-reported mild hypoglycemia | No | 2 episodes I group; 2 episodes C group; p=0.93 | No definition provided | ||||
| Diabetes Interactive Diary Rossi 20136 6 months Moderate quality Italy | Number: 127
Age: Mean I group 38.4; mean C group 34.3 Diabetes severity: Duration of diabetes (years) I group 16.2; C group 15.0 Mean HbA1c (%): I group 8.4; C group 8.5 Comorbidities: retinopathy: I group 16 %; C group 19% symptomatic neuropathy: I group 2%; C group 2% “other chronic complications”: I group 17%; C group 16% Key I/E criteria: basal-bolus regimen with insulin analogs, self-monitored BG measurements at least 3 times a day. Excluded ppts treated with NPH insulin or soluble regular insulin, insulin pump, or insulin regimens other than basal bolus. | Same as above | Standard education | HbA1C(%)* | No | −0.49 ± 0.11 in intervention vs −0.48 ± 0.11 in control (p=0.73) | NA |
| Fasting Blood Glucose (mg/dl) | No | −1.66 ± 12.26 in intervention vs −32.28 ± 11.76 in control (p=0.07) | NA | ||||
| Glucose variability | No | 5.36 ± 6.60 in intervention vs −5.47 ± 6.40 in control (p=0.24) | Mean Amplitude of Glucose Excursions | ||||
| Blood pressure (mmHg) | No | SBP:−0.72 ± 1.51 in intervention vs −2.00 ± 1.45 in control (p=0.54) DBP: −2.00 ± 0.94 in intervention vs 0.16 ± 0.91 in control (p=0.47) | NA | ||||
| Lipids | No | Total cholesterol (mg/dl): 3.74 ± 4.36 in intervention vs −0.63 ± 4.21 in control (p=0.47) HDL(mg/dl): 1.09 ± 1.60 in intervention vs −0.25 ± 1.57 in control (p=0.71) LDL(mg/dl): 8.27 ± 4.39 in intervention vs 5.08 ± 4.37 in control (p=0.61) Triglycerides (mg/dl): 0.39 ± 3.82 in intervention vs −6.23 ± 3.73 in control (p=0.22) | NA | ||||
| Weight (kg) | No | 0.38 ± 0.38 in intervention vs 0.28 ± 0.36 in control (p=0.85) | NA | ||||
| Diabetes treatment satisfaction | No | 0.89 ± 0.89 in intervention vs 1.97 ± 0.88 in control (p=0.39) | Diabetes Treatment Satisfaction Questionnaire | ||||
| Grade 1 hypoglycemia | No | Incidence Risk Ratio: 1.08 (1.00-1.16) | Symptomatic or asymptomatic BG < 60 mg/dl not requiring medical assistance | ||||
| Grade 2 hypoglycemia | Yes | Incidence Risk Ratio 0.14 (0.07-0.29) | Coma, seizure or significant neurologic impairment or required assistance | ||||
| Quality of Life | No | 1.30 ± 1.36 in intervention vs—0.91 ± 1.35 in control (p=0.25) | Diabetes Specific Quality of Life Scale | ||||
| Diabeo Charpentier 20117 6 months Moderate quality France | Number: 180
Age: Mean 33.8 Diabetes severity: Duration of diabetes 16.4 years; Insulin pump 37% Comorbidities: retinopathy 30% nephropathy 12% clinical neuropathy 11 % Key I/E criteria: HbA1c> 8% and treated with basal bolus insulin for minimum 6 months | Diabeo software on smartphone includes prandial insulin dose advisor which accounts for self-monitored BG, carbohydrate counts and planned physical activity. Software recommends adjustments in carbohydrate-to-insulin ratio, long acting insulin dose or pump basal rate. Smartphone with Diabeo software automatically uploads from phone to secure Web Site available to providers and ppts. [2 intervention groups:
Group 2- Diabeo software alone and Group 3- Diabeo software and teleconsultations] | Group 1 (control) ppts kept paper logbooks and attended two follow-up hospital clinic visits (3 and 6-months) | HbA1C(%) | Yes | Group 1 vs Group 2: −0.67% [0.35, 0.99] p< 0.001
Group 1 vs Group 3: −0.91% [0.60, 1.21] p< 0.001 Group 2 vs Group 3: 0.24% [−0.08, 0.56] p = 0.417 | NA |
| Quality of life | No | NR, p=0.1271 | Diabetes Quality of Life | ||||
| Quality of life | No | Disinhibited eating subset, NR, p=0.7872
Psychological distress subset, NR, p=0.2447 Barriers to activity subset, NR, p=0.5906 | Diabetes Health Profile Questionnaire | ||||
| Major hypoglycemic episodes | CND | G1-3 episodes;
G2-3 episodes; G3-1 episode | Requiring third-party assistance | ||||
| Minor hypoglycemic episodes | CND | Intervention group did not differ from control at study end (4.6 ± 4.0). | Symptomatic, nonsevere self-reported by ppt within 14 days before baseline and endpoint visits | ||||
| Diabeo Franc 20138 *subgroup analysis of Charpentier 20117 which is Moderate quality France | Ppts of Charpentier study divided into Diabeo system high users and system low users based on median percentage of informed meals (informed meal defined as meal which Diabeo system proposed an insulin dose based on pre-prandial BG or fasting BG, physical activity, and expected carbohydrate consumption) Age: median [25-75th percentile]: high user 33 vs low user 25 Diabetes severity Duration of diabetes median [25-75th percentile]: high user 17 vs low user 14 Insulin pump: NR Comorbidities: NR | (same as above) | (same as above) | HbA1C(%) | No | High system users: decrease HbA1C of 0.5 % for both intervention groups (Group 1 vs Group 2 and Group 3) Low system users: decrease in HbA1C of 0.8% for both intervention groups (Group 1 vs Group 2 and Group 3) | NA |
BG=blood glucose; C=control; CND=could not determine; DBP=diastolic blood pressure; HDL=high-density lipoprotein; I=intervention; I/E=inclusion/exclusion; LDL=low-density lipoprotein; NA=not applicable; NR=not reported; PHQ=patient health questionnaire; ppts=participants; SBP=systolic blood pressure; SMBG=self-monitored blood glucose; SUS=System Usability Scale
Table C-2Study details for apps for type 2 diabetes
| App Name Author & Year Length of Study ROB Assessment | Participants | Intervention | Comparator | Outcome | Significant improvement in intervention vs. comparator | Outcome results | Outcome Measurement Details |
|---|---|---|---|---|---|---|---|
| BlueStar Diabetes Quinn 20089 3 months Low quality United States | Number: 30 ppts Age: Mean 51.04 Diabetes severity: Diabetes duration: 11 years (intervention) vs. 7.6 years (control) Baseline HbA1c: 9.51 % (intervention) vs. 9.05% (control) Comorbidities: BMI (kg/m2:) 34.07 (intervention) vs. 34.58 (control) 62% hypertension 54% hyperlipidemia 4% coronary artery disease 31% microvascular complications | Intervention ppts were given app with Bluetooth-enabled blood glucose meter. All ppts used mobile phones to label BG from blood glucose meter and enter carbohydrates & medications. Based on BG values, ppts received positive feedback or instructions to test BG or emailed questions to determine the root of problem. All suggested medication changes were sent to ppts and their physicians. Ppts received feedback related to nutrition, lifestyle, state of change and self-management skills and were referred to a diabetes educator if more help was needed. | Usual care (UC): control ppts were given BG meter and asked to send BG logbooks every 2 weeks to physician. Physicians followed usual standards of care for patients’ diabetes management. | HbA1C(%) | Yes | Intervention group decreased 2.03% vs. control group decreased 0.68% (p <0.04) | NA |
| Increase in medication dosage | Yes | Intervention group 84.6% vs. control group 23.3% (p= 0.002) | NA | ||||
| Self-entered medication errors identified by app | Yes | Intervention group 53.4% vs. control group 0% (p =0.002) | NA | ||||
| New depression diagnosis | No | Intervention group 9% vs. control group 20% (p=0.37) | NA | ||||
| Self-care behaviors | CND | Cumulative score for tool not reported. | Summary of Diabetes Self Care Activities, 5-domain measurement including diet (specific and general), exercise, glucose testing, smoking, and foot care. | ||||
| Improved knowledge of food choices | No | Intervention group 91% vs. control group 50%, p=0.062 | Self-reported control issues survey (developed by authors) | ||||
| Self-reported satisfaction with provider care | Yes | Intervention group 100% vs. control group 37.5%, p=0.004 | Self-reported control issues survey (developed by authors) | ||||
| Confidence about diabetes control | No | Intervention group 100% vs. control group 75%, p=0.167 | Self-reported control issues survey (developed by authors) | ||||
| Satisfaction with app | Yes (intervention only) | “At least 91%” of users were satisfied with specific components of app | Survey questions of patient satisfaction (feedback messages, cell phone use, medical team approach, and time saving) | ||||
| BlueStar Diabetes Quinn 201110 12 months Low quality United States | Number: 163 ppts Age: mean 52.8 Diabetes severity: Diabetes duration: 8.2 years Insulin pump: None Baseline HbA1c: 9.4% Comorbidities: 76.1% of ppts obese (BMI>30 kg/m2) Mean PHQ-9 of 5.2 indicating minimal to mild depression 63.2% hypertension 58.3% hypercholesterolemia | Intervention ppts were split into 3 groups: coach only (CO), coach PCP portal (CPP), and coach PCP portal with decision support (CPDS). All ppts used mobile phones to record BG, carbohydrates, & medications and received algorithm-derived educational and motivational messages. Virtual case managers intermittently reviewed data and provided feedback, and participants could reach out to case managers. In the CO group, providers could receive data from participants if they shared it. In the CPP and CPDS group, providers were trained on accessing data through an online portal and in the CPDS group, providers also received quarterly reports summarizing participants’ progress and relevant evidence-based guidelines. | Usual care (UC): providers reviewed ppts blood glucose (BG) meter readings and BG logbooks when made available by ppts, and providing care accordingly | HbA1C(%) | Yes for CPDS and CO, No for CPP | CPDS-UC: favors intervention, difference of -1.2% [-.5 to -1.9%] P=.001 CO-UC: favors intervention, p=.027 CPP-UC: no difference, p=.40 | NA |
| Blood pressure | No | SBP: NR, p>.05 DBP: NR, p>.05 | NA | ||||
| Lipid profile | No | LDL: NR, p>.05 HDL: NR, p>.05 Triglycerides: NR, p>.05 Total cholesterol: NR, p>.05 | NA | ||||
| Hypoglycemic events | CND | “Infrequent in all groups” | Not defined | ||||
| Health care utilization | CND | Hospitalizations: “Infrequent in all groups.” 1 ppt hospitalized twice in for reasons not reported in the study ER visits: “Infrequent in all groups” | NA | ||||
| Death | No | No deaths in either group | NA | ||||
| Diabetes Distress | No | NR, p>.05 | Diabetes Distress Scale | ||||
| Diabetes symptoms | No | NR, p>.05 | Self-Completion Patient Outcome Instrument | ||||
| Depression | No | NR, p>.05 | PHQ-9 | ||||
| Adverse events | No | None reported. | NA | ||||
| BlueStar Diabetes Quinn 201411* subgroup analysis for Quinn 2011 which is low quality 12 months United States | Number: 118 ppts Age: 60% of intervention vs 52% of control were <55 years old Diabetes severity: Diabetes duration: For those <55 years old, mean diabetes duration was lower in intervention than control (6.8 vs. 8.9 years). For those ≥55 years old, mean diabetes duration was higher in intervention than control (10.3 vs. 9.2 years). Insulin pump: none HbA1c: For those <55 years old, HbA1c was 9.9% for both intervention and control. For those ≥55 years old, HbA1c was 9.8% in intervention vs. 8.4% in control. Comorbidities: 61% hypertension 59% hypercholesterolemia 8% coronary artery disease 12% microvascular complication | CPDS above. | Same as above. | HbA1c (%) | Yes, for younger and older ppts | Younger (<55 years): .1.0% [.1.8, .0.2] P=.02. Older (≥55 years): .1.4% [.2.3, 0.6] P =.001. | NA |
| mDiab Takenga 201412 2 months Low quality Democratic Republic of Congo | Number: 40 Age: Mean 53.3 in intervention; mean 53.35 in control Diabetes severity: Diabetes duration: NR Insulin pump: NR Baseline HbA1c: Mean 8.67% for intervention vs. 8.59% for control Comorbidities: NR | Ppts can input data using their mobile devices (Android, iPhone, and iPads) and/or web-based applications. App collects information on blood glucose, insulin intake, sports done with duration, BP measurements, body weight and size, via manual entry or syncing with blood glucose meter. Doctors send therapy plans, instructions, and recommendations to mobile app or email/SMS. App connects to a web-based health portal which can be accessed by users, doctors, and hospital and system administrators | Conventional therapy without the use of telemedicine system | HbA1c (%) | CND | Intervention group decreased from 8.67% to 6.89%. Control group increased from 8.59% to 8.6%. | NA |
| Usability and design | Yes (intervention only) | Mean 7 out of 10 (intervention only) | 5 questions assessing ppt perceptions how often they successfully used the system, how easy it was to use the system and how they would evaluate the input, output, visualization and design of the application | ||||
| Efficiency and therapy satisfaction | Yes (intervention only) | Mean 7.43 out of 10 (intervention only) | 2 questions assessing ppt perceptions on whether app motivated them to control BG levels and whether feedback from doctors helped. | ||||
| Acceptance and appreciation | Yes (intervention only) | Mean 8.65 out of 10 (intervention only) | NR (article says this measurement was based on 2 questions but doesn–t say what those were) | ||||
| Glucose variability (mg/dL) | CND | Standard deviation at follow up was 33 in intervention and 48.16 in control. | Standard deviation of mean BG | ||||
| NexJ Health Coach + Wayne 201513 6 months Moderate Quality Canada | Number: 138 ppt Age: mean 53.2 Diabetes severity: Diabetes duration: NR Insulin pump: NR Baseline HbA1c: 8.69% in intervention vs. 8.89% in control Comorbidities: NR | App supports ppts in health-related goal setting and progress monitoring. Ppts manually enter data, communicate with health coach at any time via secure messaging, and schedule phone contact and/or in-person meetings through app. | Ppts received health coach support in selecting and progressing toward goals without access to a study-provided mobile phone or software. Ppts received health coach support in selecting and progressing toward goals without access to a study-provided mobile phone or software. | HbA1c (%) | No | Intent-to-treat analysis: Intervention-control difference of -0.152; P=0.48 Per protocol analysis: Intervention-control difference of .055; p=.83 | NA |
| Weight (kg) | CND | Intervention group lost 1.22 (.35-2.08) kg, control group gained .45 (-1.33 to .44) kg. | NA | ||||
| Waist circumference (cm) | CND | Intervention group lost 2.23 (.53-3.93) cm, control group gained .122 (-1.89 to 1.64) cm. | NA | ||||
| BMI (kg/m2) | CND | Intervention group lost .21 (-.24 to .66), control group lost .21 (-.68 to .25) kg/m2. | NA | ||||
| Life satisfaction | CND | Intervention group increased by 3.72 (1.50-5.94) and control group increased by 3.77 (1.3-6.24). | Satisfaction with Life Scale | ||||
| Depression & anxiety | CND | Depression: Intervention group decreased by 1.81 (-2.81 to -.82) and control group decreased by 1.7 (-2.73 to -.67). Anxiety: Intervention group decreased by 1.12 (-2.29 to .05) and control group decreased by 1.5 (-2.73 to -.27). | Hospital anxiety and depression scale | ||||
| Quality of life | CND | Physical: Intervention group increased by 2.69 (.21 to 5.17) and control group increased by 2.92 (.24 to 5.6). Mental: Intervention group increased by 2.48 (-1.1 to 6.05) and control group increased 2.82 (-1.05 to 6.69). | SF-12 | ||||
| Affect | CND | Negative affect: Intervention group decreased by 2.03 (-4.87 to .8). Control group decreased by .57 (-3.55 to 2.41). Positive affect: Intervention group increased by 1.6 (-1 to 4.2). Control group increased by .44 (-2.3 to 3.18) | Positive and Negative Affect Schedule (PANAS) | ||||
| Gather Health Kleinman 201614 6 months Low Quality India | Number: 91 ppts Age: Mean 48.4 Diabetes severity: Diabetes duration: Median 10 years Insulin pump: NR Baseline HbA1c: Mean 9.3% Comorbidities: NR | System supports self-management, facilitates participant-provider communication, and enables treatment changes between visits using participant’s mobile phone apps and provider web portals and mobile phone apps. | Usual care consisting of free visits, laboratory tests, and test strips and lancets | HbA1c | Yes | Using only ppts who had follow-up data, intervention group decreased 1.5% and control group decreased 0.8% (P=0.02). Using all participants and last observation carried forward, the difference was still significant (P=0.045). Using all participants and imputation from treatment arm means, the difference was not significant (P=0.06). | NA |
| WellTang Zhou 201615 3 months Moderate Quality China | Number: 100 ppts, including 18 with type 1 and 82 with type 2 diabetes Age: mean 55 years in intervention vs. 53.5 in control Diabetes severity: Diabetes duration: mean of 6.65 years in intervention vs. 6.63 in control Insulin pump: NR Baseline HbA1c: 9.86% in intervention vs. 9.76% in control Comorbidities: 40% Hypertension 20% Hyperlipidemia 12% Coronary artery disease | App provided information on diet, exercise, medicine, blood glucose monitoring, and summaries of the latest guidelines (knowledge). Participants could enter their self-care data (blood glucose values, carbohydrate intake, medications, and other diabetes management information) which was transferred to secure servers to generate into computer-generated logbooks (self-management). Participants could ask questions and receive feedback from study team on blood glucose, target goals, and individualized medication regimens (communication). | Physicians reviewed blood glucose readings, logbooks, and adjusted medication regimens to targeted goals once a month | Satisfaction | Yes (intervention only) | 84% satisfaction rate | 1 item where 1 means satisfied and 0 means not satisfied with the use of the application. |
| HbA1c (%)* | Yes | Intervention group changed -1.95% and control group changed -.79% from baseline, P <0.001 | NA | ||||
| Fasting blood glucose (mmol/L) | Yes | -1.89 ± 2.61 in intervention vs. -0.95 ± 1.54 in control (P < 0.01) | NA | ||||
| 2-hour post-breakfast blood glucose (mmol/L) | Yes | -4.39 ± 4.43 in intervention vs. -2.81 ± 2.69 control (P < 0.01). | NA | ||||
| Blood pressure (mmHg) | No | SBP: Intervention group decreased from 134.2 ± 19.7 to 132.2 ± 19.2 vs. control decreased from 134.2 ± 20.2 to 133.6 ± 15.5 (P>.05) DBP: Intervention group decreased from 76.8 ± 11.5 to 75.8 ± 11.1 vs. control decreased from 77.1 ± 11.4 to 76.8 ± 11.3 (P>.05) | NA | ||||
| LDL-C | No | Intervention group decreased from 2.42 ± 0.81 to 2.34 ± 0.57 vs. control decreased from 2.48 ± 0.80 to 2.43 ± 0.64 in (P >.05). | NA | ||||
| Weight (kg) | No | Intervention group decreased from 62.4 ± 12.8 to 62.2 ± 11.0 vs. control increased from 62.5 ± 12.8 to 62.7 ± 12.1 (P>.05). | NA | ||||
| BMI (kg/m2) | No | Intervention group decreased from 23.04 ± 4.09 to 23.01 ± 3.58 vs. control increased from 23.01 ± 4.04 to 23.10 ± 3.81 (P>.05). | NA |
BG=blood glucose; CND=could not determine; DBP=diastolic blood pressure; HDL=high density lipoprotein; I/E=inclusion/exclusion; LDL=low-density lipoprotein; NA=not applicable; NR=not reported; PHQ=Patient Health Questionnaire; ppts=participants; SBP=systolic blood pressure
Full References of Included Studies
- 1.
- Kirwan M, Vandelanotte C, Fenning A, et al Diabetes self-management smartphone application for adults with type 1 diabetes: randomized controlled trial. J Med Internet Res. 2013;15(11):e235. DOI: 10.2196/jmir.2588. PMID: 24225149 [PMC free article: PMC3841374] [PubMed: 24225149] [CrossRef]
- 2.
- Garg SK, Shah VN, Akturk HK, et al Role of mobile technology to improve diabetes care in adults with type 1 diabetes: The remote-T1D study iBGStar(R) in type 1 diabetes management. Diabetes Ther. 2017;8(4):811–819. DOI: 10.1007/s13300-017-0272-5. PMID: 28555339. [PMC free article: PMC5544609] [PubMed: 28555339] [CrossRef]
- 3.
- Drion I, Pameijer LR, van Dijk PR, et al The effects of a mobile phone application on quality of life in patients with type 1 diabetes mellitus: A randomized controlled trial. Diabetes Sci Technol. 2015;9(5):1086–1091. DOI: 10.1177/1932296815585871. PMID: 25963412. [PMC free article: PMC4667348] [PubMed: 25963412] [CrossRef]
- 4.
- Skrovseth SO, Arsand E, Godtliebsen F, et al Data-driven personalized feedback to patients with type 1 diabetes: A randomized trial. Diabetes Technol Ther. Jul 2015;17(7):482–489. DOI: 10.1089/dia.2014.0276. PMID: 25751133. [PMC free article: PMC4504254] [PubMed: 25751133] [CrossRef]
- 5.
- Rossi MC, Nicolucci A, Di Bartolo P, et al Diabetes interactive diary: A new telemedicine system enabling flexible diet and insulin therapy while improving quality of life: an open-label, international, multicenter, randomized study. Diabetes Care. Jan 2010;33(1):109–115. DOI: 10.2337/dc09-1327. PMID: 19808926. [PMC free article: PMC2797954] [PubMed: 19808926] [CrossRef]
- 6.
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