Efficacy of Mobile Apps to Support the Care of Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Bráulio Cezar Bonoto, Vânia Eloisa de Araújo, Isabella Piassi Godói, Lívia Lovato Pires de Lemos, Brian Godman, Marion Bennie, Leonardo Mauricio Diniz, Augusto Afonso Guerra Junior, Bráulio Cezar Bonoto, Vânia Eloisa de Araújo, Isabella Piassi Godói, Lívia Lovato Pires de Lemos, Brian Godman, Marion Bennie, Leonardo Mauricio Diniz, Augusto Afonso Guerra Junior

Abstract

Background: Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health apps.

Objective: The aim of our study was to evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist DM patients in treatment.

Methods: We conducted searches in the electronic databases MEDLINE (Pubmed), Cochrane Register of Controlled Trials (CENTRAL), and LILACS (Latin American and Caribbean Health Sciences Literature), including manual search in references of publications that included systematic reviews, specialized journals, and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, patients with DM, and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager software version 5.3.

Results: The literature search identified 1236 publications. Of these, 13 studies were included that evaluated 1263 patients. In 6 RCTs, there were a statistical significant reduction (P<.05) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (mean difference, MD -0.44; CI: -0.59 to -0.29; P<.001; I²=32%).The evaluation favored the treatment in patients who used apps without significant heterogeneity.

Conclusions: The use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care by contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly by reducing their fear of not knowing how to deal with potential hypoglycemic episodes that may occur.

Keywords: diabetes mellitus; mobile applications; self-care; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Bráulio Cezar Bonoto, Vânia Eloisa de Araújo, Isabella Piassi Godói, Lívia Lovato Pires de Lemos, Brian Godman, Marion Bennie, Leonardo Mauricio Diniz, Augusto Afonso Guerra Junior. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 01.03.2017.

Figures

Figure 1
Figure 1
Flowchart of selection of references to systematic review.
Figure 2
Figure 2
Analysis of the risk of bias.
Figure 3
Figure 3
Forest-plot of glycated hemoglobin of diabetes patients who used a health app and have access physically or remotelly to health professionals.
Figure 4
Figure 4
Forest plot of glycated hemoglobin of diabetes patients who used a health app according to the number of selected app features.

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