The Efficacy of Mobile Phone Apps for Lifestyle Modification in Diabetes: Systematic Review and Meta-Analysis

Abstract

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Diabetes and related complications signify US727 billion dollars in costs yearly. Type 1 diabetes, Type 2 diabetes, and gestational diabetes are three subtypes of diabetes which share the same behavioral risk factors with prediabetic conditions. The efforts taken in lifestyle modifications can improve the health levels of diabetics and reduce the risks of contracting diabetes. However, lifestyle modifications mainly performed in a face-to-face manner is costly and leads to few people undertaking services for diabetes management. Alternatively, smartphone applications provide mobile platforms for the monitoring of lifestyle factors, as well as for health education; and different types of feedback. Objective: The purpose of this review is to assess the efficacy of smartphone applications for both patients with different subtypes of diabetes as well as prediabetic patients in the short and long terms. Methods: In June 2018, literature retrieval was conducted in five databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO). Inclusion criteria were randomized controlled trials involving diabetics or prediabetic patients, aged 18 or above. Lifestyle outcomes investigated were physical activities and healthy diets. All the studies included in this review were assessed by Cochrane Collaboration’s risk of bias tool. Meta-analysis conducted for HbA1c (glycated hemoglobin) investigated the mean effect of post-treatment (or the mean change from the baseline) with standard deviations. Subgroup analysis was conducted if possible. Heterogeneity was tested by I2. Results: A total of 2,669 articles was identified through database searching, and of these, 26 articles, 23 studies were included in this review and 18 studies were eligible for meta-analysis. Among the studies, five of them examined Type 1 diabetes, 11 examined Type 2 diabetes and two of them examined prediabetic patients. Regarding Type 1 diabetes, the overall effect on HbA1c was statistically insignificant (P=0.42) with acceptable heterogeneity (I2=39%) in the short term. Heterogeneity existed between the short-term and long-term subgroups (I2=64%). Regarding Type 2 diabetes, the overall effect on HbA1c was statistically significant (P<0.01) without heterogeneity in the short term. The overall effect on HbA1c was statistically significant (P<0.01) with an acceptable heterogeneity of I2=2%) in the long term. Heterogeneity did not exist between the short-term and long-term subgroups. For prediabetic patients, the overall effect on HbA1c was statistically insignificant (P=0.67) with the heterogeneity of I2=65%. Also, the publication bias of the Type 2 diabetes studies was assessed by the trim and fill method, and showed no effect on the overall effect size of the 11 studies. Conclusions: This review demonstrated the efficacy of smartphone applications for the different subtypes of diabetes and prediabetic conditions. For Type 1 diabetes, the efficacy of smartphone applications seemed insignificant in the short term. Concerning Type 2 diabetes, the efficacy of smartphone applications showed an attenuation with prolonged time usage. As for prediabetic conditions, heterogeneity existed between a small number of studies. More research with prediabetic conditions and long-term follow-up in Type 1 diabetes cases, we propose, should be conducted to assess the efficacy of apps, respectively.