Diabetes Management: Mobile Phone Applications Used Within Healthcare Systems for Type 1 Diabetes Self-Management

Related Pages

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine whether diabetes self-management mobile phone apps are effective at reducing blood glucose in patients with type 1 diabetes. While the included studies showed favorable results, there were too few to draw a conclusion.

The CPSTF has related findings for mobile phone applications used within healthcare systems for type 2 diabetes (recommended).

The full CPSTF Finding and Rationale Statement and supporting documents for Diabetes Management: Mobile Phone Applications Used Within Healthcare Systems for Type 1 Diabetes Self-Management are available in The Community Guide Collection on CDC Stacks.

Intervention

Mobile phone applications (apps) are used within healthcare systems to improve diabetes self-management among patients with type 1 diabetes. Patients enter data into apps or use medical equipment that transmits data directly. The apps then provide patients with feedback from healthcare professionals or automated systems. The interventions aim to facilitate communication between patients and healthcare providers and improve diabetes care.

About The Systematic Review

The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to diabetes management.

Hou C, Carter B, Hewitt J, Francisa T, Mayor S. 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.

The review included four studies that targeted patients with type 1 diabetes (search period January 1996 June 2015). The CPSTF finding is based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF.

Study Characteristics

Interventions were implemented in healthcare systems in the following countries:

  • Australia (1 study), France (1 study), Italy (1 study), and multiple European Union countries (1 study)

Study participants had the following demographic characteristics:

  • Mean age of 35.5 years (4 studies)
  • 59.1% female (4 studies)
  • Diagnosis of type 1 diabetes for a mean of 16.5 years (4 studies)

Intervention characteristics:

  • Three unique apps with functionalities including carbohydrate and insulin bolus calculator, medication adjustment support, graphical feedback, automated feedback, and healthcare professional feedback were evaluated
  • Intervention duration ranged from 6 to 9 months, with a median of 6 months

Summary of Results

  • Compared with usual care, mobile phone apps implemented in healthcare settings reduced blood glucose levels (A1c) by 0.9% and 1.4% (2 studies)
  • Compared with teaching carbohydrate counting to patients face-to-face, teaching the same techniques through mobile phone apps resulted in similar reductions in A1c levels and less time needed to learn the same materials (apps took a median of 6 hours, control groups took a median of 12 hours)

Summary of Economic Evidence

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

  • Are self-management apps implemented in healthcare systems effective in reducing A1c levels among patients with type 1 diabetes?
  • Are diabetes self-management apps available in app stores effective in reducing A1c levels for users with type 1 diabetes?
  • What factors influence app effectiveness?
    • Number of functionalities offered?
    • Specific functionalities offered?
    • Type of feedback (i.e., none, automated, personalized feedback from healthcare professionals, or a combination of the latter two)?
    • Demographic characteristics such as age, race and ethnicity, income, and education?
    • Users’ health literacy?

Implementation Considerations and Resources

Despite the finding of insufficient evidence, the following are considerations for implementation drawn from studies included in the evidence review, the broader literature, and expert opinion.

  • When implemented in the United States, mobile apps need to have measures to protect patients’ privacy and be compliant with state policies regarding application of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to protect electronic communications with patients
  • Mobile apps may provide an easier way for patients with type 1 diabetes to plan their carbohydrate intake and insulin doses and gain some independence from their long-term condition. More research is needed to determine if these apps are effective for patients with type 1 diabetes