Diabetes Management: Mobile Phone Applications Used Within Healthcare Systems for Type 2 Diabetes Self-Management
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends the use of diabetes self-management mobile phone applications (apps), when implemented in healthcare systems, to improve blood glucose among patients with type 2 diabetes. Apps may provide automated feedback or send messages from healthcare providers.
The CPSTF has related findings for mobile phone applications used within healthcare systems for type 1 diabetes (insufficient evidence).
The full CPSTF Finding and Rationale Statement and supporting documents for Diabetes Management: Mobile Phone Applications Used Within Healthcare Systems for Type 2 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 2 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 nine studies that had patients with type 2 diabetes (search period January 1996 June 2015). The team examined each of the studies included in the systematic review and abstracted supplemental information about study, intervention, and population characteristics.
Study Characteristics
Interventions were implemented in healthcare systems in the following countries:
- Studies were conducted in the United States (3 studies), Finland (1 study), Japan (1 study), Korea (1 study), Norway (1 study), and the United Kingdom (2 studies)
- All of the studies evaluated mobile phone apps implemented within a healthcare system
Study participants had the following demographic characteristics:
- Mean age of 57.7 years (8 studies)
- 43.7% female (8 studies)
- Diagnosis of type 2 diabetes for a mean of 8.8 years (6 studies)
Intervention characteristics:
- Eight unique apps with functionalities including medication adjustment support, graphical feedback, automated feedback, and healthcare professional feedback were evaluated
- Intervention duration ranged from 3 to 12 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 a median of 0.4% (9 studies)
- Apps that provided feedback from healthcare professionals produced greater reductions in blood glucose levels when compared to apps that only offered automated feedback (mean reductions in A1c of 0.58% and 0.44%, respectively)
- Patients 55 years of age or younger experienced greater reductions in A1c when compared with patients over 55 years of age (mean reductions in A1c of 1.03% and 0.41%, respectively)
Summary of Economic Evidence
A systematic review of economic evidence has not been conducted.
Applicability
Based on results for interventions in different settings and populations, findings should be applicable to women and men with type 2 diabetes who are living in high income countries.
Evidence Gaps
- Are diabetes self-management apps available in app stores effective in reducing A1c levels for users with type 2 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 race and ethnicity, income, and education?
- Users’ health literacy?
Implementation Considerations and Resources
- All of the included studies evaluated the effectiveness of these apps when used within healthcare systems. The CPSTF finding is limited to interventions used in these settings, and the CPSTF does not endorse any specific mobile applications or technology
- For U.S. healthcare systems to implement effective mobile phone apps within their patient populations, certain issues need to be taken into consideration:
- Involvement of healthcare professionals. Review findings suggest that when healthcare professionals (including patients’ primary care providers) delivered feedback, patients had greater reductions in A1c levels when compared to patients who only received automated feedback
- Compliance with Health Insurance Portability and Accountability Act (HIPAA). Implementers should understand state policies regarding application of HIPAA to electronic communications with patients
- Resource requirements for patients. Disparities in smart phone ownership and access to data services exist across population groups with different levels of income or educational attainment. To use these apps in healthcare systems, implementers need to ensure all patients with diabetes have equal access to, and opportunity for, long-term use
- Ease of using mobile phone apps. Older adults are much less likely to own a mobile phone. Findings from this review suggest that interventions were less effective with patients over 55 years of age when compared to patients 55 years or younger. Implementers need to be aware of this age divide and consider providing more training for older patients
- None of the included studies examined apps available via app stores, providing no further guidance on ways to determine their effectiveness
- The American Medical Association (AMA) issued guidelines in 2016 about the potential to incorporate these apps into daily care. AMA encourages its members to follow evidence-based guidelines where available and use apps proven to support care delivery that is patient-centered, promotes care coordination, and facilitates team-based communication
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.