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  • Therapies and New Technologies in the Treatment of Diabetes (M Pietropaolo, Section Editor)
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Diabetes Care in the Digital Era: a Synoptic Overview


Purpose of Review

Diabetes care is undergoing a remarkable transformation by the advancements in information and communications technology (ICT). The aim of this review is to provide a general overview of various ICT-based interventions for diabetes care, challenges of their adoption, and consider future directions.

Recent Findings

A number of systematic reviews have examined studies on various aspects of telemedicine and eHealth for diabetes care, but they are generally focused on one specific type of technology application for diabetes care.


A wide range of solutions from manual or automated telephone calls, short message services, websites, mobile health apps, remote monitoring devices, and sophisticated artificial intelligence systems has been studied in different settings and scopes with mixed results. However, despite the promising results of research studies, such innovative solutions are not widely adopted by health systems worldwide. Lack of supportive policy and legislation, unsustainable reimbursement, inefficient business models, and concerns regarding the security and privacy of health data are among the most problematic barriers.

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Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40–50.

    Article  PubMed  CAS  Google Scholar 

  2. 2.

    Torjesen I. More than half of diabetes patients are not getting standard health checks. BMJ. 2012;344:e3393.

    Article  PubMed  Google Scholar 

  3. 3.

    World Health Organisation. Global diffusion of eHealth: making universal health coverage achievable: report of the third global survey on eHealth. Geneva: WHO; 2016.

    Google Scholar 

  4. 4.

    Fatehi F, Wootton R. Telemedicine, telehealth or e-health? A bibliometric analysis of the trends in the use of these terms. J Telemed Telecare. 2012;18:460–4.

    Article  PubMed  Google Scholar 

  5. 5.

    Suksomboon N, Poolsup N, Nge YL. Impact of phone call intervention on glycemic control in diabetes patients: a systematic review and meta-analysis of randomized, controlled trials. PLoS One. 2014;9:e89207.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. 6.

    Wei J, Zheng H, Wang L, et al. Effects of telephone call intervention on cardiovascular risk factors in type 2 diabetes mellitus: a meta-analysis. J Telemed Telecare. [Epub ahead of print].

  7. 7.

    • Posadzki P, Mastellos N, Ryan R, et al. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev. 2016;12:CD009921. Recent Cochrane systematic review of the studies on automated telephone calls for the prevention and management of chronic conditions.

    PubMed  Google Scholar 

  8. 8.

    Ramadas A, Quek KF, Chan CK, et al. Web-based interventions for the management of type 2 diabetes mellitus: a systematic review of recent evidence. Int J Med Inform. 2011;80:389–405.

    Article  PubMed  CAS  Google Scholar 

  9. 9.

    Ebert DD, Nobis S, Lehr D, Baumeister H, Riper H, Auerbach RP, et al. The 6-month effectiveness of internet-based guided self-help for depression in adults with type 1 and 2 diabetes mellitus. Diabet Med. 2017;34:99–107.

    Article  PubMed  CAS  Google Scholar 

  10. 10.

    Fatehi F, Armfield NR, Dimitrijevic M, Gray LC. Technical aspects of clinical videoconferencing: a large scale review of the literature. J Telemed Telecare. 2015;21:160–6.

    Article  PubMed  Google Scholar 

  11. 11.

    Fatehi F, Armfield NR, Dimitrijevic M, Gray LC. Clinical applications of videoconferencing: a scoping review of the literature for the period 2002-2012. J Telemed Telecare. 2014;20:377–83.

    Article  PubMed  Google Scholar 

  12. 12.

    Fatehi F, Gray LC, Russell AW. A clinimetric study of outpatient diabetes consultations: the potential for telemedicine substitution. Diabetes Technol Ther. 2014;16:8–14.

    Article  PubMed  Google Scholar 

  13. 13.

    Fatehi F, Gray LC, Russell AW. Telemedicine for clinical management of diabetes—a process analysis of video consultations. J Telemed Telecare. 2013;19:379–82.

    Article  PubMed  Google Scholar 

  14. 14.

    Fatehi F, Gray LC, Russell AW, Paul SK. Validity study of video teleconsultation for the management of diabetes: a pilot randomized controlled trial. Diabetes Technol Ther. 2015;17:717–25.

    Article  PubMed  Google Scholar 

  15. 15.

    Fatehi F, Martin-Khan M, Smith AC, Russell AW, Gray LC. Patient satisfaction with video teleconsultation in a virtual diabetes outreach clinic. Diabetes Technol Ther. 2015;17:43–8.

    Article  PubMed  Google Scholar 

  16. 16.

    Lee SWH, Chan CKY, Chua SS, Chaiyakunapruk N. Comparative effectiveness of telemedicine strategies on type 2 diabetes management: a systematic review and network meta-analysis. Sci Rep. 2017;7:12680.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. 17.

    • Wade VA, Eliott JA, Hiller JE. Clinician acceptance is the key factor for sustainable telehealth services. Qual Health Res. 2014;24:682–94. Qualitative study on sustainability of telehealth services.

    Article  PubMed  Google Scholar 

  18. 18.

    Hall AK, Cole-Lewis H, Bernhardt JM. Mobile text messaging for health: a systematic review of reviews. Annu Rev Public Health. 2015;36:393–415.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Russell N, Vess J, Durham C, et al. Text-messaging to support diabetes self-management in a rural health clinic: a quality improvement project. Online J Nurs Inf (OJNI). 2017;21.

  20. 20.

    Dobson R, Whittaker R, Pfaeffli Dale L, Maddison R. The effectiveness of text message-based self-management interventions for poorly-controlled diabetes: a systematic review. Digit Health 2017;3:

  21. 21.

    Dobson R, Whittaker R, Jiang Y, Shepherd M, Maddison R, Carter K, et al. Text message-based diabetes self-management support (SMS4BG): study protocol for a randomised controlled trial. Trials. 2016;17:179.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Fortmann AL, Gallo LC, Garcia MI, Taleb M, Euyoque JA, Clark T, et al. Dulce digital: an mHealth SMS-based intervention improves glycemic control in Hispanics with type 2 diabetes. Diabetes Care. 2017;40:1349–55.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Levy N, Moynihan V, Nilo A, Singer K, Bernik LS, Etiebet MA, et al. The mobile insulin titration intervention (MITI) for insulin adjustment in an urban, low-income population: randomized controlled trial. J Med Internet Res. 2015;17:e180.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Kitsiou S, Pare G, Jaana M, et al. Effectiveness of mHealth interventions for patients with diabetes: an overview of systematic reviews. PLoS One. 2017;12:e0173160.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. 25.

    • Arambepola C, Ricci-Cabello I, Manikavasagam P, et al. The impact of automated brief messages promoting lifestyle changes delivered via mobile devices to people with type 2 diabetes: a systematic literature review and meta-analysis of controlled trials. J Med Internet Res. 2016;18:e86. Systematic review and meta-analysis of automated text messaging on life style change.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Dobson R, Carter K, Cutfield R, Hulme A, Hulme R, McNamara C, et al. Diabetes text-message self-management support program (SMS4BG): a pilot study. JMIR Mhealth Uhealth. 2015;3:e32.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    • Burke LE, Ma J, Azar KM, Bennett GG, Peterson ED, Zheng Y, et al. Current science on consumer use of mobile health for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 2015;132:1157–213. Summarized data to provide guidance regarding use of mHealth for prevention of cardiovascular diseases.

    Article  PubMed  Google Scholar 

  28. 28.

    Ramachandran A, Snehalatha C, Ram J, Selvam S, Simon M, Nanditha A, et al. Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol. 2013;1:191–8.

    Article  PubMed  Google Scholar 

  29. 29.

    Pew Research Center. Smartphone ownership and internet usage continues to climb in emerging economies. 2016.

  30. 30.

    Fatehi F, Gray LC, Russell AW. Mobile health (mHealth) for diabetes care: opportunities and challenges. Diabetes Technol Ther. 2017;19:1–3.

    Article  PubMed  Google Scholar 

  31. 31.

    Fu H, McMahon SK, Gross CR, et al. Usability and clinical efficacy of diabetes mobile applications for adults with type 2 diabetes: a systematic review. Diabetes Res Clin Pract. 2017;131:70–81.

    Article  PubMed  Google Scholar 

  32. 32.

    Holtz BE, Murray KM, Hershey DD, Richman J, Dunneback JK, Vyas A, Wood MA: The design and development of MyT1DHero: a mobile app for adolescents with type 1 diabetes and their parents. J Telemed Telecare 2017:1357633X17745470.

  33. 33.

    Community Preventive Services Task Force. Diabetes management: mobile phone applications used within healthcare systems for type 2. Diabetes Self Manag. 2017.

  34. 34.

    • Hou C, Carter B, Hewitt J, et al. 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;39:2089–95. Systematic review and meta-analysis of mobile apps on glycaemic control.

    Article  PubMed  Google Scholar 

  35. 35.

    Ding H, Fatehi F, Russell AW, et al.. User experience of an innovative mobile health program to assist in insulin dose adjustment: outcomes of a proof-of-concept trial. Telemed J E Health.[ePub ahead of print].

  36. 36.

    Hsu WC, Lau KH, Huang R, et al. Utilization of a cloud-based diabetes management program for insulin initiation and titration enables collaborative decision making between healthcare providers and patients. Diabetes Technol Ther. 2016;18:59–67.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. 37.

    FDA approves first automated insulin delivery device for type 1 diabetes. Accessed 30 December 2017.

  38. 38.

    Forlenza GP, Buckingham B, Maahs DM. Progress in diabetes technology: developments in insulin pumps, continuous glucose monitors, and progress towards the artificial pancreas. J Pediatr. 2016;169:13–20.

    Article  PubMed  Google Scholar 

  39. 39.

    McAdams BH, Rizvi AA. An overview of insulin pumps and glucose sensors for the generalist. J Clin Med. 2016;5:5.

    Article  PubMed Central  CAS  Google Scholar 

  40. 40.

    Farrington C. Hacking diabetes: DIY artificial pancreas systems. Lancet Diabetes Endocrinol. 2017;5:332.

    Article  PubMed  Google Scholar 

  41. 41.

    Gomez-Galvez P, Mejías CS, Fernandez-Luque L. Social media for empowering people with diabetes: current status and future trends. Paper presented at: 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC); 25–29 Aug 2015. 2015.

  42. 42.

    Greene JA, Choudhry NK, Kilabuk E, Shrank WH. Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook. J Gen Intern Med. 2011;26:287–92.

    Article  PubMed  Google Scholar 

  43. 43.

    • Patel R, Chang T, Greysen SR, Chopra V. Social media use in chronic disease: a systematic review and novel taxonomy. Am J Med. 2015;128:1335–50. Sytematic review of contemporary social media on clinical outcomes of chronic conditions.

    Article  PubMed  Google Scholar 

  44. 44.

    Liu Y, Mei Q, Hanauer DA, Zheng K, Lee JM. Use of social media in the diabetes community: an exploratory analysis of diabetes-related tweets. JMIR Diabetes. 2016;1:e4.

    Article  PubMed  Google Scholar 

  45. 45.

    Petrovski G, Zivkovic M. Impact of Facebook on glucose control in type 1 diabetes: a three-year cohort study. JMIR Diabetes. 2017;2:e9.

    Article  PubMed  Google Scholar 

  46. 46.

    Nainggolan L. Social media use in diabetes: a fad, or here to stay? Accessed 26-Dec-2017.

  47. 47.

    Dale JR, Williams SM, Bowyer V. What is the effect of peer support on diabetes outcomes in adults? A systematic review. Diabet Med. 2012;29:1361–77.

    Article  PubMed  CAS  Google Scholar 

  48. 48.

    Sayers SL, Riegel B, Pawlowski S, Coyne JC, Samaha FF. Social support and self-care of patients with heart failure. Ann Behav Med. 2008;35:70–9.

    Article  PubMed  Google Scholar 

  49. 49.

    Bartholomew K. Diabetes support group teams up on social media to help distressed, newly-diagnosed man. Accessed 26-Dec-2017.

  50. 50.

    Driscoll KA. Considerations in using serious videogames as a method for providing diabetes education. Diabetes Technol Ther. 2016;18:47–8.

    Article  PubMed  Google Scholar 

  51. 51.

    Barry MJ, Edgman-Levitan S. Shared decision making—pinnacle of patient-centered care. N Engl J Med. 2012;366:780–1.

    Article  PubMed  CAS  Google Scholar 

  52. 52.

    Hayes DF, Markus HS, Leslie RD, Topol EJ. Personalized medicine: risk prediction, targeted therapies and mobile health technology. BMC Med. 2014;12:37.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    American Diabetes A. 1. Improving care and promoting health in populations: standards of medical care in diabetes—2018. Diabetes Care. 2018;41:S7–S12.

    Article  Google Scholar 

  54. 54.

    Primary Health Care Advisory Group Report. Better outcomes for people with chronic and complex health conditions. Canberra, Department of Health, Commonwealth of Australia; 2015.

  55. 55.

    Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998:2–4.

  56. 56.

    Gee PM, Greenwood DA, Paterniti DA, Ward D, Miller LMS. The eHealth enhanced chronic care model: a theory derivation approach. J Med Internet Res. 2015;17:e86.

    Article  PubMed  PubMed Central  Google Scholar 

  57. 57.

    Jackson CL, Hambleton SJ. Australia’s health care homes: laying the right foundations. Med J Aust. 2017;206:380–1.

    Article  PubMed  Google Scholar 

  58. 58.

    Fatehi F, Smith AC, Maeder A, Wade V, Gray LC. How to formulate research questions and design studies for telehealth assessment and evaluation. J Telemed Telecare. 2017;23:759–63.

    Article  PubMed  Google Scholar 

  59. 59.

    Greenhalgh T, Russell J. Why do evaluations of eHealth programs fail? An alternative set of guiding principles. PLoS Med. 2010;7:e1000360.

    Article  PubMed  PubMed Central  Google Scholar 

  60. 60.

    Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A'Court C, et al. Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. J Med Internet Res. 2017;19:e367.

    Article  PubMed  PubMed Central  Google Scholar 

  61. 61.

    • Weinstein RS, Lopez AM, Joseph BA, Erps KA, Holcomb M, Barker GP, et al. Telemedicine, telehealth, and mobile health applications that work: opportunities and barriers. Am J Med. 2014;127:183–7. Summarized enablers and barriers of the adoption of telemedicine.

    Article  PubMed  Google Scholar 

  62. 62.

    Juniper Research. Health Monitoring Device Adoption to Triple to 70m by 2020 as FDA Approvals Open the Floodgates. Accessed 25 December 2017.

  63. 63.

    Juniper Research. Chatbots, a game changer for banking & healthcare, saving $8 billion annually by 2022. Accessed 25 Dec 2017.

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Farhad Fatehi is financially supported by the Queensland Government through an Advance Queensland Research Fellowship. Anish Menon is a recipient of Diabetes Queensland Scholarship. Anish Menon and Dominique Bird are financially supported by the Centre of Research Excellence in Telehealth funded by the Australian National Health and Medical Research Council (NHMRC; grant ID APP1061183).

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All authors contributed to the writing and revising of the manuscript.

Corresponding author

Correspondence to Farhad Fatehi.

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Conflict of Interest

Farhad Fatehi and Anish Menon declare that they have no conflict of interest.

Dominique Bird has a patent from Bupa Australia Digital Diabetes scripts - Monash University with royalties paid.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Therapies and New Technologies in the Treatment of Diabetes

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Fatehi, F., Menon, A. & Bird, D. Diabetes Care in the Digital Era: a Synoptic Overview. Curr Diab Rep 18, 38 (2018).

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  • Diabetes
  • Telehealth
  • Telemedicine
  • eHealth
  • mHealth
  • Digital health