Smartphone Apps May Improve Self-Management in Type 2 Diabetes

When added to usual care, smartphone applications, commonly referred to as “apps,” may help patients with type 2 diabetes self-manage their condition, researchers reported in Diabetes Care.¹

“With the number of patients globally with diabetes expected to rise to  [more than]500 million by 2030, there is an urgent need for better self-management,” Ben Carter, PhD, of Cardiff University’s School of Medicine, said in a press release.² “As we enter an era where portable technology is increasingly used to improve our lifestyles, as can already be seen with physical activity technology, apps can offer a large percentage of the world’s population a low-cost and dynamic solution to type 2 diabetes management.”

To further investigate whether smartphone apps may have a role in diabetes care, Dr Carter and colleagues evaluated randomized controlled trials of diabetes apps in patients with type 1 and type 2 diabetes published between January 1, 1996, and June 1, 2015, from the Medline, CINAHL, Cochrane Library, Web of Science, and Embase databases. The researchers then conducted a systematic review  with meta-analysis and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) of the evidence.

Fourteen studies involving 1360 participants were included in the review. In the 10 studies of participants with type 2 diabetes, mean HbA1c was reduced with the use of a smartphone app vs no app use (mean reduction: 0.49%; 95% CI, 0.30-0.68).¹ GRADE of evidence was moderate.¹ The researchers noted that, in subgroup analyses, younger patients were more likely to benefit from use of the apps and that feedback from health care professionals enhances the effect size.¹

Data from studies involving patients with type 1 diabetes were less promising. In 2 studies, statistically significant results favored app use, but the difference in HbA1c between the intervention and control groups was statistically insignificant in the other 2 studies (-0.36%; 95% CI, -0.87 to0.14; P =.16).¹ There were no reported subgroup analyses for these studies.

“In a clinical context, we recommend that [health care professional] feedback should be central in all future app designs and supplemented with dynamic automated feedback,” the researchers concluded. “Future technology should also be underpinned by behavior change theories and gamification elements to achieve a larger effect on [blood glucose] control and improve compliance of patients in using diabetes apps. Finally, future technology should also consider the needs of older patients.”

Dr Carter offered insight into the potential implications of these findings.¹ “By the end of the decade it is predicted that global usage of mobile phones will exceed 5 billion, so apps, used in combination with other self-management strategies, could form the basis of diabetes education and self-management,” he noted in the release.

Disclosures: The authors report no conflicts of interest.

References

1. Hou C, Carter B, Hewitt J, Francisa T, Mayor S. Do mobile phone applications improve glycemic control (HbA1c) in the self-management of diabetes? A systematic review, meta-analysis, and GRADE of 14 randomized trials. Diabetes Care. 2016;39:2089–2095. doi:10.2337/dc16-0346.
2. Health benefits of apps [news release]. Cardiff, UK: Cardiff University School of Medicine News; October 26, 2016. http://www.cardiff.ac.uk/news/view/498876-health-benefits-of-apps. Accessed October 31, 2016.