Cited by 283Mobile Health and mHealth ApplicationsDiabetes Management and EducationDigital Mental Health Interventions

Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy

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Wu, Yuan, Yao, Xun, Vespasiani, Giacomo, Nicolucci, Antonio, Dong, Yajie, Kwong, Joey, Li, Ling, Sun, Xin +2 more·2017·JMIR mHealth and uHealth

Abstract

Background: Mobile health apps for diabetes self-management have different functions. However, the efficacy and safety of each function are not well studied, and no classification is available for these functions. Objective: The aims of this study were to (1) develop and validate a taxonomy of apps for diabetes self-management, (2) investigate the glycemic efficacy of mobile app-based interventions among adults with diabetes in a systematic review of randomized controlled trials (RCTs), and (3) explore the contribution of different function to the effectiveness of entire app-based interventions using the taxonomy. Methods: We developed a 3-axis taxonomy with columns of clinical modules, rows of functional modules and cells of functions with risk assessments. This taxonomy was validated by reviewing and classifying commercially available diabetes apps. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Chinese Biomedical Literature Database, and ClinicalTrials.gov from January 2007 to May 2016. We included RCTs of adult outpatients with diabetes that compared using mobile app-based interventions with usual care alone. The mean differences (MDs) in hemoglobin A1c (HbA1c) concentrations and risk ratios of adverse events were pooled using a random-effects meta-analysis. After taxonomic classification, we performed exploratory subgroup analyses of the presence or absence of each module across the included app-based interventions. Results: Across 12 included trials involving 974 participants, using app-based interventions was associated with a clinically significant reduction of HbA1c (MD 0.48%, 95% CI 0.19%-0.78%) without excess adverse events. Larger HbA1c reductions were noted among patients with type 2 diabetes than those with type 1 diabetes (MD 0.67%, 95% CI 0.30%-1.03% vs MD 0.37%, 95% CI –0.12%-0.86%). Having a complication prevention module in app-based interventions was associated with a greater HbA1c reduction (with complication prevention: MD 1.31%, 95% CI 0.66%-1.96% vs without: MD 0.38%, 95% CI 0.09%-0.67%; intersubgroup P=.01), as was having a structured display (with structured display: MD 0.69%, 95% CI 0.32%-1.06% vs without: MD 0.69%, 95% CI –0.18%-0.53%; intersubgroup P=.03). However, having a clinical decision-making function was not associated with a larger HbA1c reduction (with clinical decision making: MD 0.19%, 95% CI –0.24%-0.63% vs without: MD 0.61%, 95% CI 0.27%-0.95%; intersubgroup P=.14). Conclusions: The use of mobile app-based interventions yields a clinically significant HbA1c reduction among adult outpatients with diabetes, especially among those with type 2 diabetes. Our study suggests that the clinical decision-making function needs further improvement and evaluation before being added to apps.

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Authors
Wu, Y., Yao, X., Vespasiani, G., Nicolucci, A., Dong, Y., Kwong, J., Li, L., Sun, X., Tian, H., & Li, S.
Affiliations
  • Sichuan University (CN)
  • Center for Outcomes Research and Clinical Epidemiology (IT)
Corresponding author
Li, Sheyu
Venue
JMIR mHealth and uHealth
Published
2017-03-14
Volume
5
Issue
3
Pages
e35
ISSN
2291-5222 (ISSN-L)
OpenAlex
W3159078634
Cited by
283
References
46
Citations by year
2026: 13 · 2025: 23 · 2024: 24 · 2023: 20 · 2022: 35 · 2021: 27 · 2020: 44 · 2019: 48 · 2018: 33 · 2017: 16
FWCI
6.79
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR mhealth and uhealth (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Natural Science Foundation of China (2015CB942800, 21534008, 81400811)
  • Sichuan University
  • National Key Research and Development Program of China (2015CB942800)
  • West China Hospital, Sichuan University
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
mobile health apps, diabetes self-management, glycemic control, HbA1c, type 1 diabetes, type 2 diabetes, complication prevention, adverse events, smartphone-based intervention, diabetes education, diabetes self-monitoring, medication reminders, exercise recommendations, sleep monitoring, blood glucose monitoring

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