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Effective Health Care Program

Mobile Applications for Self-Management of Diabetes

Technical Brief

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Key Messages

Purpose of Review

This review evaluates the efficacy, usability, and features of commercially available mobile applications (apps) for diabetes self-management.

Key Messages

  • Although hundreds of apps for diabetes self-management are commercially available, we only identified health outcomes studies on 11 apps.
  • Of the 11 apps, studies showed only 5 were associated with clinically significant improvements in HbA1c, an important clinical test for monitoring diabetes. (For Type 1 diabetes- Glucose Buddy, Diabeo Telesage; For Type 2 diabetes- Blue Star, WellTang, Gather Health)
  • None of the studies showed patient improvements in quality of life, blood pressure, weight, or body mass index. More rigorous and longer-term research studies could determine whether apps help people manage their diabetes and reduce complications.
  • Studies had methodological issues: they were short (2-12 months); inconsistent in reporting of randomization, allocation, masking, and drop-out analysis; and often used co-interventions that hindered interpretation of results. None of the included studies are considered to be high quality.

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.

Citation

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. DOI: https://doi.org/10.23970/AHRQEPCTB31.

Journal Article

Veazie S, Winchell K, Gilbert J, et al. Rapid Evidence Review of Mobile Applications for Self-Management of Diabetes. J Gen Intern Med. 2018 May 3. https://link.springer.com/article/10.1007/s11606-018-4410-1 doi: 10.1007/s11606-018-4410-1