The Efficacy of Mobile Phone Apps for Lifestyle Modification in Diabetes: Systematic Review and Meta-Analysis

Abstract

BackgroundDiabetes and related complications are estimated to cost US $727 billion worldwide annually. Type 1 diabetes, type 2 diabetes, and gestational diabetes are three subtypes of diabetes that share the same behavioral risk factors. Efforts in lifestyle modification, such as daily physical activity and healthy diets, can reduce the risk of prediabetes, improve the health levels of people with diabetes, and prevent complications. Lifestyle modification is commonly performed in a face-to-face interaction, which can prove costly. Mobile phone apps provide a more accessible platform for lifestyle modification in diabetes.ObjectiveThis review aimed to summarize and synthesize the clinical evidence of the efficacy of mobile phone apps for lifestyle modification in different subtypes of diabetes.MethodsIn June 2018, we conducted a literature search in 5 databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and PsycINFO). We evaluated the studies that passed screening using The Cochrane Collaboration’s risk of bias tool. We conducted a meta-analysis for each subtype on the mean difference (between intervention and control groups) at the posttreatment glycated hemoglobin (HbA1c) level. Where possible, we analyzed subgroups for short-term (3-6 months) and long-term (9-12 months) studies. Heterogeneity was assessed using the I2 statistic.ResultsWe identified total of 2669 articles through database searching. After the screening, we included 26 articles (23 studies) in the systematic review, of which 18 studies (5 type 1 diabetes, 11 type 2 diabetes, and 2 prediabetes studies) were eligible for meta-analysis. For type 1 diabetes, the overall effect on HbA1c was statistically insignificant (P=.46) with acceptable heterogeneity (I2=39%) in the short-term subgroup (4 studies) and significant heterogeneity between the short-term and long-term subgroups (I2=64%). Regarding type 2 diabetes, the overall effect on HbA1c was statistically significant (P<.01) in both subgroups, and when the 2 subgroups were combined, there was virtually no heterogeneity within and between the subgroups (I2 range 0%-2%). The effect remained statistically significant (P<.01) after adjusting for publication bias using the trim and fill method. For the prediabetes condition, the overall effect on HbA1c was statistically insignificant (P=.67) with a large heterogeneity (I2=65%) between the 2 studies.ConclusionsThere is strong evidence for the efficacy of mobile phone apps for lifestyle modification in type 2 diabetes. The evidence is inconclusive for the other diabetes subtypes.

My Diabetes Coach, a Mobile App–Based Interactive Conversational Agent to Support Type 2 Diabetes Self-Management: Randomized Effectiveness-Implementation Trial

“…Despite the growing number of studies using mobile technologies for diabetes management [ 10 , 11 , 15 ], the effectiveness of introducing apps to people with T2DM to support their self-management at large scale remains uncertain given the generally poor quality of apps [ 12 , 13 , 32 ], unmet consumer needs [ 14 ], and studies lacking robust designs with long-term evaluations [ 10 , 15 ]. The MDC program is highly innovative with its conversational element.…”

“…Furthermore, people with diabetes expect apps to be engaging; incorporating multiple functions; and covering a broad range of content, including psychological and emotional support [ 14 ]. Although some recent systematic reviews and meta-analyses have indicated a modest effect for app-based interventions to support diabetes self-management [ 10 , 11 , 15 ], there still remains a great deal of uncertainty about their feasibility, acceptability, and effectiveness in the real world [ 10 , 15 - 17 ].…”

Primary Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus Using Mobile Health Technology: Systematic Review of the Literature

“…Previous mobile health research has focused more on self-management of chronic diseases than on prevention. In their systematic review and meta-analysis, Wu et al [ 34 ] investigated the effectiveness of mobile phone apps for diabetes self-management (including prediabetes, gestational diabetes, type 1 diabetes, and T2DM). They identified 3 studies that targeted prediabetes, 2 of which we also included in this review.…”

“…They identified 3 studies that targeted prediabetes, 2 of which we also included in this review. The overall conclusion of Wu et al [ 34 ] was that there was evidence for the effectiveness of app interventions in T2DM self-management, but not for prediabetes. Lunde et al [ 35 ] conducted a systematic review looking at various types of noncommunicable diseases and lifestyle advice.…”

Diabetes, Sport und Bewegung

“…Diverse Gesundheits-Apps zur Optimierung des Lebensstils können für die Prävention und Therapie genutzt werden [26][27][28][29]. Es gibt Gesundheits-Apps zum Selbstmanagement bei Gestationsdiabetes [27,30] oder Smartphone-Apps für Sportler mit Typ-1-Diabetes [31]. Ihre Qualität und ihr Nutzen sollten wissenschaftlich belegt sein und erst dann sollten sie allgemein empfohlen werden.…”