Rapid Evidence Review of Mobile Applications for Self-management of Diabetes
Patients with diabetes lack information on which commercially available applications (apps) improve diabetes-related outcomes. We conducted a rapid evidence review to examine features, clinical efficacy, and usability of apps for self-management of type 1 and type 2 diabetes in adults.
Ovid/Medline and the Cochrane Database of Systematic Reviews were searched for systematic reviews and technology assessments. Reference lists of relevant systematic reviews were examined for primary studies. Additional searches for primary studies were conducted online, through Ovid/Medline, Embase, CINAHL, and ClinicalTrials.gov. Studies were evaluated for eligibility based on predetermined criteria, data were extracted, study quality was assessed using a risk of bias tool, information on app features was collected, and app usability was assessed. Results are summarized qualitatively.
Fifteen articles evaluating 11 apps were identified: six apps for type 1 and five apps for type 2 diabetes. Common features of apps included setting reminders and tracking blood glucose and hemoglobin A1c (HbA1c), medication use, physical activity, and weight. Compared with controls, use of eight apps, when paired with support from a healthcare provider or study staff, improved at least one outcome, most often HbA1c. Patients did not experience improvements in quality of life, blood pressure, or weight, regardless of app used or type of diabetes. Study quality was variable. Of the eight apps available for usability testing, two were scored “acceptable,” three were “marginal,” and three were “not acceptable.”
Limited evidence suggests that use of some commercially available apps, when combined with additional support from a healthcare provider or study staff, may improve some short-term diabetes-related outcomes. The impact of these apps on longer-term outcomes is unclear. More rigorous and longer-term studies of apps are needed.
This review was funded by the Agency for Healthcare Research and Quality (AHRQ). The protocol is available at: http://www.effectivehealthcare.ahrq.gov/topics/diabetes-mobile-devices/research-protocol.
KEY WORDSdiabetes telemedicine self-management consumer health informatics decision making
The authors gratefully acknowledge the following individuals: Ian Anderson, James Case, Lily Cook, Makalapua Motu’apuaka, Ryan McKenna, Ed Reid, and Leah Williams. The authors of this manuscript are responsible for its content. Statements in the manuscript do not necessarily represent the official views of or imply endorsement by AHRQ, U.S. Department of Health of Human Services (HHS), or the National Institutes of Health. Preliminary results of this review were presented at the AcademyHealth 10th Annual Conference on the Science of Dissemination and Implementation in Health on December 4, 2017.
This project was funded under Contract Nos. HHSA29020120004C and HHSA290201700003C from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services (HHS). Dr. Ivlev was supported by National Library of Medicine Biomedical Informatics Training Grant #T15LM007088.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- 1.Centers for Disease Control and Prevention. National Diabetes Statistics Report (2017). Estimates of diabetes and its burden in the United States. 2017; Available at: http://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed January 29, 2018.
- 2.Beck J GD, Blanton L, Bollinger ST, Butcher MK et al. National standards for diabetes self-management education and support. 2017. Available at: http://professional.diabetes.org/sites/professional.diabetes.org/files/media/2017_national_standards_for_dsmes_public_comment.pdf. Accessed January 29, 2018.
- 3.U.S. Department of Health and Human Services, Federal Office of Rural Health Policy. Telehealth Programs. Nov 2015; Available at: https://www.hrsa.gov/rural-health/telehealth/index.html. Accessed Jan 29, 2018.
- 4.World Health Organization. Telemedicine: opportunities and developments in member states. 2010; Available at: http://www.who.int/goe/publications/goe_telemedicine_2010.pdf. Accessed Jan 29, 2018.
- 6.Pai A. Survey: 58 percent of smartphone users have downloaded a fitness or health app. Mobi Health News 2015; Available at: http://www.mobihealthnews.com/48273/survey-58-percent-of-smartphone-users-have-downloaded-a-fitness-or-health-app. Accessed Jan 29, 2018.
- 7.Mobile health technology for diabetes: research protocol. Agency for Healthcare Research and Quality (AHRQ) Effective Health Program. 2017; Available at: https://www.effectivehealthcare.ahrq.gov/topics/diabetes-mobile-devices/research-protocol. Accessed Jan 29, 2018.
- 8.Federal Register. Supplemental evidence and data request on mobile health technology for diabetes. A notice by the Agency for Healthcare Research and Quality. 8/15/2017. Document Citation 82 FR 38691. 2017; Available at: https://www.federalregister.gov/documents/2017/08/15/2017-17152/supplemental-evidence-and-data-request-on-mobile-health-technology-for-diabetes. Accessed Jan 29, 2018.
- 9.Viswanathan M, Ansari MT, Berkman ND, et al. Assessing the risk of bias of individual studies in systematic reviews of health care interventions. Agency for Healthcare Research and Quality methods guide for effectiveness and comparative effectiveness reviews. Mar 2012. AHRQ Publication No. 12-EHC047-EF. Available at: www.effectivehealthcare.ahrq.gov/.
- 10.Brooke J. SUS: a ‘quick and dirty’ usability scale. In: Weerdmeester; McClelland I, ed. Usability Evaluation in Industry. London: Taylor and Francis; 1996:189–194.Google Scholar
- 11.Bangor A, Kortum P, Miller J. Determining what individual SUS scores mean: adding an adjective rating scale. J Usability Stud. 2009;4(3):114–123.Google Scholar
- 12.Glucose Buddy. Azumio Inc. Apple App Store. 2012. Available at: https://itunes.apple.com/us/app/glucose-buddy-diabetes-logbook-manager-w-syncing-blood/id294754639?mt=8. Accessed Jan 22, 2018.
- 13.Glucose Buddy. Azumio, Inc. Google Play. 2012. Available at: https://play.google.com/store/apps/details?id=com.skyhealth.glucosebuddyfree&hl=en. Accessed Jan 22, 2018.
- 15.Glucose Buddy Pro. Azumio Inc. Apple App Store. 2012. Available at: https://itunes.apple.com/us/app/glucose-buddy-pro-diabetes-managing-logbook-w-blood/id533299240?mt=8. Accessed Jan 22, 2018.
- 16.Diabetes Manager. iTenuto Soft. Apple App Store 2016; Available at: https://itunes.apple.com/us/app/diabetes-manager/id368455341?mt=8. Accessed Jan 22, 2018.
- 17.Garg SK, Shah VN, Akturk HK, Beatson C, Snell-Bergeon JK. 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 Therapy: Research, Treatment and Education of Diabetes and Related Disorders. May 29 2017.Google Scholar
- 18.Dbees Freshware. Amazon App Store. 2012. Available at: https://www.amazon.com/gp/product/?ie=UTF8&ASIN=B004XWHBIU&ref=mas_ty. Accessed Jan 22, 2018.
- 19.Dbees. Freshware. Apple App Store. 2012. Available at: https://itunes.apple.com/us/app/dbees-com-diabetes-under-control/id408492591?mt=8. Accessed Jan 22, 2018.
- 21.Diabetes Diary. Nasjonalt senter for samhandling og telemedisin. Google Play. 2017. Available at: https://play.google.com/store/apps/details?id=no.telemed.diabetesdiary&hl=en. Accessed Jan 22, 2018.
- 23.Diabetes Interactive Diary. Meteda. Google Play. 2017. Available at: https://play.google.com/store/apps/details?id=it.meteda.did. Accessed 2018, Jan 22.
- 26.Diabeo Telesage. Sanofi. Apple App Store. 2017. Available at: https://itunes.apple.com/fr/app/diabeo-telesage/id595993009?l=en&mt=8. Accessed Jan 22, 2018.
- 27.Diabeo Telesage. Sanofi. Google Play. Available at: https://play.google.com/store/apps/details?id=com.sanofi.fr.diabeo&hl=en. Accessed Jan 22, 2018.
- 28.Charpentier G, Benhamou PY, Dardari D, et al. The Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support improves HbA1c in poorly controlled type 1 diabetic patients: a 6-month, randomized, open-label, parallel-group, multicenter trial (TeleDiab 1 Study). Diabetes Care 2011;34(3):533–539.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.BlueStar Diabetes. WellDoc, Inc. Apple App Store. 2017. Available at: https://itunes.apple.com/us/app/bluestar-diabetes/id700329056?mt=8. Accessed Jan 22, 2018.
- 30.BlueStar Diabetes. WellDoc, Inc. Google Play. 2017. Available at: https://play.google.com/store/apps/details?id=com.welldoc.platform.android&hl=en. Accessed Jan 22, 2018.
- 33.mDiab Lite. Infokom GmbH. Apple App Store. 2014. Available at: https://itunes.apple.com/us/app/mdiab-lite/id604866236?mt=8. Accessed Jan 22, 2018.
- 34.mDiab Lite. Infokom GmbH. Google Play. 2013. Available at: https://play.google.com/store/apps/details?id=com.infokom.mdiab.lite&hl=en. Accessed Jan 22, 2018.
- 36.mDiab. Infokom GmbH. Apple App Store. 2017. Available at: https://itunes.apple.com/us/app/mdiab/id608181716?mt=8. Accessed Jan 22, 2018.
- 37.mDiab. Infokom GmbH. Google Play. 2014. Available at: https://play.google.com/store/apps/details?id=com.infokom.mdiab&hl=en. Accessed Jan 22, 2018.
- 38.NexJ Health Coach +. NexJ Health Inc. Apple App Store. 2016. Available at: https://itunes.apple.com/ca/app/nexj-health-coach/id1047247250?mt=8. Accessed Jan 22, 2018.
- 39.NexJ Health Coach +. NexJ Health. Google Play 2017; Available at: https://play.google.com/store/apps/details?id=com.connectedwellness.HealthCoachPlus&hl=en. Accessed Jan 22, 2018.
- 41.Gather Health Family Diabetes. Gather Health. Google Play. 2016. Available at: https://play.google.com/store/apps/details?id=com.gatherhealth.gatherdm&hl=en. Accessed Jan 22, 2018.
- 42.Gather Health. Gather Health Limited. Apple App Store. 2016. Available at: https://itunes.apple.com/us/app/gather-health/id909621891?mt=8. Accessed Jan 22, 2018.
- 44.WellTang. Apple App Store. 2017.Available at: https://appsto.re/us/aDAoR.i. Accessed Jan 22, 2018.
- 55.MedlinePlus. Type 1 diabetes. 2016; Available at: https://medlineplus.gov/ency/article/000305.htm. Accessed Jan 29, 2018.
- 56.Hartling L, Guise JM, Kato E, et al. AHRQ comparative effectiveness reviews. EPC Methods: an Exploration of Methods and Context for the Production of Rapid Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015.Google Scholar