Translational Behavioral Medicine

, Volume 3, Issue 3, pp 277–286 | Cite as

Adherence to evidence-based guidelines among diabetes self-management apps

Original Research


Smartphone apps can provide real-time, interactive self-management aid to individuals with diabetes. It is currently unclear whether existing diabetes self-management apps follow evidence-based guidelines. The purpose of this study was to evaluate the extent to which existing diabetes self-management apps address the seven self-management behaviors recommended by the American Association of Diabetes Educators (the AADE7™). The term “diabetes” identified relevant self-management apps via the Apple App Store search engine in March 2012. Ratings were based on app descriptions and downloads. Chi-square analyses assessed differences in apps based on developer type. Apps promoted a median of two AADE7™ skills. Overall reliability between description and download ratings was good (kappa = .66). Reliability of individual skills was variable (kappa = .25 to .91). Most diabetes apps do not conform to evidence-based recommendations, and future app reviews would benefit from testing app performance. Future apps may also benefit from theory-based designs.


Diabetes mHealth Apps Self-management Smartphone Technology 


  1. 1.
    Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. 2011.Google Scholar
  2. 2.
    Association AD. Economic costs of diabetes in the U.S. in 2007. Diabetes Care.2008;31(3):596-615.CrossRefGoogle Scholar
  3. 3.
    Hernández-Ronquillo L, Téllez-Zenteno JF, Garduño-Espinosa J, et al. Factors associated with therapy noncompliance in type-2 diabetes patients. Salud Publica Mex.2003;45(3):191-197.PubMedCrossRefGoogle Scholar
  4. 4.
    Kirk A, Mutrie N, MacIntyre P, et al. Increasing physical activity in people with type 2 diabetes. Diabetes Care.2003;26(4):1186-1192.PubMedCrossRefGoogle Scholar
  5. 5.
    Rubin RR. Adherence to pharmacologic therapy in patients with type 2 diabetes mellitus. Am J Med.2005;118(Suppl 5A):27S-34S.PubMedCrossRefGoogle Scholar
  6. 6.
    Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med.2006;166(17):1836-1841.PubMedCrossRefGoogle Scholar
  7. 7.
    Lim S, Kang SM, Shin H, et al. Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous healthcare service, a new medical information system. Diabetes Care.2011;34(2):308-313.PubMedCrossRefGoogle Scholar
  8. 8.
    As smartphone prices fall, retailers are leaving money on the table, according to The NPD Group. Available at: Accessed 29 July 2012.
  9. 9.
    Pew Internet and American Life Project. The social life of health information and the Internet. Available at: Accessed 29 July 2012
  10. 10.
    Purcell K. Half of adult cell phone owners have apps on their phones.Pew Research Center’s Internet and American Life Project; 2011. Available at: Accessed 29 July 2012
  11. 11.
    Breton E, Fuemmeler B, Abroms L. Weight loss—there is an app for that! But does it adhere to evidence-informed practices? Transl Behav Med.2011;1(4):523-529.CrossRefGoogle Scholar
  12. 12.
    Chomutare T, Fernandez-Luque L, Årsand E, et al. Features of mobile diabetes applications: review of the literature and analysis of current applications compared against evidence-based guidelines. J Med Internet Res. 2011;13(3):e65.PubMedCrossRefGoogle Scholar
  13. 13.
    American Association of Diabetes Educators. AADE7, Self-Care Behaviors. Available at: Accessed on 29 July 2012
  14. 14.
    Franko OI, Tirrell TF. Smartphone app use among medical providers in ACGME training programs. J Med Syst. 2012;36(5):3135-3139.PubMedCrossRefGoogle Scholar
  15. 15.
    Cicchetti D. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess.1994;6(4):284-290.CrossRefGoogle Scholar
  16. 16.
    Leventhal H, Bodnar-Deren S, Breland JY, et al. Modeling health and illness behavior: the approach of the commonsense model. In: Baum AS, Revenson TA, Singer J, eds. The Handbook of Health Psychology.Secondth ed. New York: Erlbaum; 2011:3-35.Google Scholar
  17. 17.
    Clar C, Barnard K, Cummins E, et al. Aberdeen Health Technology Assessment G. Self-monitoring of blood glucose in type 2 diabetes: systematic review. Health Technol Assess.2010;14(12):1-140.Google Scholar
  18. 18.
    Malanda UL, Welschen LM, Riphagen II, Dekker JM, Nijpels G, Bot SD. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. In: Cochrane Database of Systematic Reviews. Wiley;2012.Available at: Accessed 3 June 2012
  19. 19.
    D’Zurilla TJ, Nezu AM. Problem-solving Therapy. 3rd ed. New York: Springer; 2007.Google Scholar
  20. 20.
    Hill-Briggs F, Lazo M, Peyrot M, et al. Effect of problem-solving-based diabetes self-management training on diabetes control in a low income patient sample. J Gen Intern Med.2011;26(9):972-978.PubMedCrossRefGoogle Scholar
  21. 21.
    Dimeff L, Paves AP, Skutch JM, et al. Shifting paradigms in clinical psychology: How innovative technologies are shaping treatment delivery. In: Barlow DH, ed. The Oxford Handbook of Clinical Psychology.New York: Oxford University Press; 2001:618-648.Google Scholar
  22. 22.
    Morris ME, Kathawala Q, Leen TK, et al. Mobile therapy: case study evaluations of a cell phone application for emotional self-awareness. J Med Internet Res.2010;12(2):e10.PubMedCrossRefGoogle Scholar
  23. 23.
    Abroms LC, Padmanabhan N, Thaweethai L, et al. iPhone apps for smoking cessation. Am J Prev Med.2011;40(3):279-285.PubMedCrossRefGoogle Scholar
  24. 24.
    Leventhal H, Leventhal EA, Breland JY. Cognitive science speaks to the “Common-Sense” of chronic illness management. Ann Behav Med.2011;41(2):1-12.CrossRefGoogle Scholar
  25. 25.
    Halm EA, Mora P, Leventhal H. No symptoms, no asthma: the acute episodic disease belief is associated with poor self-management among inner-city adults with persistent asthma. Chest.2006;129(3):573-580.PubMedCrossRefGoogle Scholar
  26. 26.
    Baumann LJ, Cameron LD, Zimmerman RS, et al. Illness representations and matching labels with symptoms. Health Psychol.1989;8(4):449-469.PubMedCrossRefGoogle Scholar
  27. 27.
    Anderson J, Rainie L. The Future of Gamification.Pew Research Center’s Internet & American Life Project; 2012. Available at: Accessed July 29, 2012.
  28. 28.
    McAndrew L, Schneider SH, Burns E, et al. Does Patient Blood Glucose Monitoring Improve Diabetes Control? Diabetes Educator.2007;33(6):991-1010.PubMedCrossRefGoogle Scholar
  29. 29.
    Cafazzo JA, Casselman M, Hamming N, et al. Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study. J Med Internet Res.2012;14(3):e70.PubMedCrossRefGoogle Scholar
  30. 30.
    Cox A. Mobile Healthcare Opportunities: Smartphone Apps, Monitoring, and mHealth Strategies 2011–2016.Hampshire: Juniper Research; 2011.Google Scholar

Copyright information

© Society of Behavioral Medicine 2013

Authors and Affiliations

  • Jessica Y. Breland
    • 1
    • 2
  • Vivian M. Yeh
    • 1
    • 2
  • Jessica Yu
    • 1
    • 2
  1. 1.Department of PsychologyRutgers, The State University of New JerseyPiscatawayUSA
  2. 2.Institute for Health, Health Care Policy and Aging ResearchRutgers, The State University of New JerseyNew BrunswickUSA

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