Improving Glycemic Control in Adults and Children With Type 1 Diabetes With the Use of Smartphone-Based Mobile Applications: A Systematic Review.

Abstract

Management of type 1 diabetes is often challenging. Smartphone mobile applications (apps) may provide additional support and help to improve glycemic control and clinical outcomes. The objectives of this study were to examine the literature evaluating the use of mobile apps (stand-alone and text messaging/feedback) in type 1 diabetes and to review top-rated mobile apps applicable to type 1 diabetes. Medline, Cochrane and Embase databases were systematically searched to identify studies published from inception to February 2018. Top-rated relevant apps from Google Play Store and Apple App Store were reviewed in July 2017. The literature search yielded 3,462 studies. Of these studies, 9 evaluated the stand-alone apps; 3 showed significant improvement in glycated hemoglobin (A1C) levels (0.5%, p<0.05, 0.57%, p<0.05, and 0.58%, p=0.02); 3 demonstrated improved adherence to glucose monitoring; and 1 study demonstrated a reduction in hypoglycemic events (glucose<3.0 mmol/L) in 6 of 10 participants who completed the study. Also, 5 studies evaluated a mobile app plus text-messaging/feedback system. Only 1 showed a significant reduction in severe hypoglycemic events (mobile app+text, IQR 0.33, 95% CI 0.17 to 0.63; vs. control, IQR 2.29, 95% CI 1.80 to 2.91), while another single study demonstrated a reduction in median glycated hemoglobin levels (0.3%; p<0.001). Most top-rated mobile apps logged parameters relevant to diabetes management, and some provided graphic analysis and set reminders. This study highlights the need for larger and longer studies to explore the efficacy of apps to optimize outcomes in type 1 diabetes, the populations that would benefit most from these tools and the resources needed to support mobile apps plus text-messaging/feedback systems.