Mobile phone apps for lifestyle modification can reduce average blood sugar levels in type 2 diabetes

Wu X, Guo X, Zhang Z. The efficacy of mobile phone apps for lifestyle modification in diabetes: Systematic review and meta-analysis JMIR Mhealth Uhealth. 2019;7:e12297.

Review question

What is the effect of mobile phone apps for lifestyle modification on different types of diabetes?

Background

Diabetes—which includes type 1 diabetes and type 2 diabetes—results in negative health outcomes and a reduced quality of life. Lifestyle changes, such as diet and exercise, can better the health of those with diabetes. Many currently available services that aim to help patients modify their lifestyle are delivered face-to-face within medical settings and/or require some degree of monitoring by a health professional. Additionally, more tailored modification strategies, such as exercise coaching and diet consultations, are not always easily accessible. Mobile phone apps are plentiful, and popular globally. Past research on diabetes apps shows the potential for this technology to help increase patients’ diabetes knowledge, improve communication with doctors, and decrease diabetes incidence. While this is encouraging, more research is needed to better understand if these apps really make a difference in health outcomes for people with diabetes. 

How the review was done

This is a systematic review of 23 randomized controlled trials published between 2008 and 2018, including a total of 2526 participants. Eighteen studies were included in a meta-analysis.

Key features of the studies:

• Participants were adults between 21 to 75 years of age who either had type 1 diabetes, type 2 diabetes, prediabetes, or obesity, or were at risk of developing type 2 diabetes. Some participants also had other chronic conditions like heart disease and chronic obstructive pulmonary disease in addition to diabetes.
• Participants used mobile apps that included a lifestyle modification component (e.g., related to diet and exercise, etc.). Some participants received feedback from health care providers via the apps, texts, emails, or phone calls.  
• Researchers measured changes in average blood sugar levels (i.e., HbA1c).
• Generally, the results were compared to people in control groups receiving usual/standard diabetes care, which include one or more of the following: care delivered by a health care practitioner at varying frequencies, annual laboratory tests and checkups, continuing with self-management/self-care, diabetes education, diabetes guidance, disease management information booklets and paper logbooks, use of pedometers, and follow-up visits at hospitals. Other control groups used: blood sugar monitors, mobile diary apps, a health coach without smartphone interaction, paper diaries for diet, exercise, and weight monitoring, and dietary health education handbooks.
• Participant follow-up ranged from three months to one year. 

What the researchers found

For type 2 diabetes, researchers found that mobile apps for lifestyle modification can reduce average blood sugar levels in the short-term (3-6 months) and long-term (9-12 months). For type 1 diabetes, these mobile apps may have no effect on average blood sugar levels in the short-term, but may lower it in the long-term. However, the long-term result was just based on one study and therefore needs to be interpreted with caution. For prediabetes, two studies showed that mobile apps had no effect on short-term control of average blood sugar levels, and there was no data on long-term effects. Overall, more long-term research on the topic, which stretches beyond 12 months, is important. Beyond type 2 diabetes, the evidence for the effects of mobile apps on type 1 diabetes and prediabetes is inconclusive, therefore more research is needed for these two specific diabetes subtypes.     

Conclusion

While phone apps with a lifestyle modification component lowered average blood sugar levels in both the short and long term for type 2 diabetes, it is not clear that this same affect occurs for other diabetes subtypes. More research, particularly with respect to long-term outcomes is needed to draw more definitive conclusions.