Effectiveness of mobile applications in diabetic patients’ healthy lifestyles: A review of systematic reviews

Highlights

• Apps improve glycemic control in patients with DM in the short term.

• Apps do not improve glycemic control in patients with DM in the long term.

• The Apps examined focused on diet and physical exercise.

• No significant adverse effects were identified for the users of the Apps.

Abstract

Objective

(1) Examine the mobile applications that address lifestyles to improve the metabolic control of adult patients with diabetes mellitus. (2) Describe the characteristics of the used mobile applications, identify the healthy lifestyles they target, and describe any of their adverse effects.

Methods

Review systematic reviews. We included studies that used any mobile application to help patients improve diabetes mellitus self-management by focusing on healthy lifestyles. Studies needed to include a control group receiving regular care with no mobile devices. In May 2018, Medline, Embase, Cochrane, LILACS, PsychINFO, Cinahl and Science Direct were searched, updated in June 2021. The methodological quality of the studies was assessed by the Amstar-2 tool.

Results

First 804 articles were analyzed to select 17 systematic reviews, of which the methodological quality of seven was high or moderate. Interventions lasted 1−12 months. Twenty-three different mobile applications were identified that were all related to eating and physical activity. Significant changes were noted in HbA1c values. No clear improvement was observed for weight/BMI, lipid profile, quality of life or blood pressure. No adverse effects were found.

Conclusions

Managing the lifestyle of patients with diabetes using mobile applications improves short-term glycemic control, but the long-term results are not conclusive. The identified mobile applications focus on food and physical activity. Most are free. No adverse effects caused by using them were identified.

PROSPERO register

CRD42019133685

Introduction

The International Diabetes Federation estimates some 425 million people are diagnosed with diabetes mellitus (DM) worldwide, whose prevalence will rise to 693 million by 2045 [1]. It is well-known that DM significantly increases cardiovascular risk and is usually associated with unhealthy lifestyle; e.g. being overweight, obesity, smoking, unbalanced diet, sedentary lifestyle [2,3]. For these reasons, DM is currently a major public health problem worldwide [4].

The rapid progress in information technology in recent years has enabled the creation of software extensions, popularly known as mobile applications (Apps) that users can add to their mobile devices (Apps). These tools are being increasingly employed to manage different health matters. In 2018, more than 100,000 such applications were available to make users’ health self-care easier [5].

The main aim of treating DM is to prevent or delay the onset of microvascular and macrovascular complications due to suitable metabolic control, where practicing healthy lifestyles is fundamental [6]. This therapeutic objective has been dealt with in the conventional health context by the doctor-patient relationship. At present, the mobile apps used for the same purpose are revolutionizing this traditional care model.

Given the substantial progress made in recent years in non face-to-face healthcare, in 2011 the World Health Organization defined the "m-health" concept as the practice of medicine and public health supported by the use of mobile devices (mobile phones, patient monitoring devices, personal digital assistants and other wireless devices) [7]. Apps allow prevention, diagnosis and treatment activities to be performed, and act as a way for professionals and patients to communicate [8].

The systematic reviews published to date about the effectiveness of using Apps to favor healthy lifestyles offer opposing and non conclusive results. Some reviews offer positive results [[9], [10], [11], [12], [13]], and the majority conclude that more research studies are necessary to assess their real effectiveness [[14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25]], while a few reviews state that these types of intervention are not effective [26,27].

Moreover, differences in facilitating elements and barriers have been described with the population using digital health platforms, which means that their accessibility and acceptability are not universal [28]. Accordingly, as part of its Action Plan on electronic health (eHealth) 2012–2020 and the Digital Agenda, the European Commission has published the “Green Paper on mobile health”, with which it intends to conduct a public consultation on current obstacles and problems related to implementing mobile health to help it reach its full potential [29].

For this review, we considered the self-control concept of DM “as the process of facilitating the knowledge, skill and ability necessary for diabetes self-care”. Its ultimate objective is to improve patients’ clinical outcomes, health status and quality of life [30]. It also attempts to answer the question: are mobile applications that deal with lifestyles to improve the metabolic control of adult patients with DM effective?

In line with this question, we consider that the main objective is to examine mobile applications that address lifestyles to improve the metabolic control of adult patients with DM. As secondary objectives, we aim to describe the characteristics of the employed apps, identify the healthy lifestyle aspect they target, and describe any adverse effects of their uses.