Popular Diabetes Apps and the Impact of Diabetes App Use on Self-Care Behaviour: A Survey Among the Digital Community of Persons With Diabetes on Social Media

Neborachko M., Pkhakadze A., Vlasenko I.

Industry 4.0 is an updated concept of smart production, which is identified with the fourth industrial revolution and the emergence of cyber-physical systems. Industry 4.0 is the next stage in the digitization of productions and industries, where such technologies and concepts as the Internet of things, big data, predictive analytics, cloud computing, machine learning, machine interaction, artificial intelligence, robotics, 3D printing, augmented reality. As an area of therapy with the best market potential and one of the most expensive global diseases, diabetes attracts the best healthcare players, who use innovative technologies. Current trends in digitalization of diabetes management are presented.

Rose K.J., Petrut C., L'Heveder R., de Sabata S.

Over the last decade, advances in technology and connectivity have led to the boom of Internet-based and mobile applications (Apps) which have rendered access to information easier and faster and have changed our daily lives. With 60 million people living with diabetes (PWD) in Europe and 32 million more at risk, diabetes has been a major target for software companies, with the aim to help people manage their chronic condition, and to prevent diabetes in people at risk. IDF Europe is the voice of 70 national associations, representing PWD and health professionals in 47 European countries, and a strong supporter of innovation in healthcare. Witnessing the emergence of Apps in the field of diabetes, given the general uptake of a connected lifestyle, and recognising the potential in the ability of these Apps to make an impact on the lives of PWD, IDF Europe reflected on Mobile Applications in Diabetes, examining Diabetes and new technology through psychology, motivation and behavioral change in diabetes management; the healthcare professional perspective; potential roles of diabetes-related Apps, pointing to existing evidence and important ethical issues; and finally offering recommendations on four levels: individual, healthcare professional, political and App developers.

Kebede M., Schuett C., Pischke C.

Background: This study investigated the determinants (with a special emphasis on the role of diabetes app use, use of continuous glucose monitoring (CGM) device, and self-care behavior) of glycemic control of type 1 and type 2 diabetes mellitus (DM). Methods: A web-based survey was conducted using diabetes Facebook groups, online patient-forums, and targeted Facebook advertisements (ads). Demographic, CGM, diabetes app use, and self-care behavior data were collected. Glycemic level data were categorized into hyperglycemia, hypoglycemia, and good control. Multinomial logistic regression stratified by diabetes type was performed. Results: The survey URL was posted in 78 Facebook groups and eight online forums, and ten targeted Facebook ads were conducted yielding 1854 responses. Of those owning smartphones (n = 1753, 95%), 1052 (62.6%) had type 1 and 630 (37.4%) had type 2 DM. More than half of the type 1 respondents (n = 549, 52.2%) and one third the respondents with type 2 DM (n = 210, 33.3%) reported using diabetes apps. Increased odds of experiencing hyperglycemia were noted in persons with type 1 DM with lower educational status (Adjusted Odds Ratio (AOR) = 1.7; 95% Confidence Interval (CI): 1.21–2.39); smokers (1.63, 95% CI: 1.15–2.32), and high diabetes self-management concern (AOR = 2.09, 95% CI: 1.15–2.32). CGM use (AOR = 0.66, 95% CI: 0.44–1.00); “general diet” (AOR = 0.86, 95% CI: 0.79–0.94); and “blood glucose monitoring” (AOR = 0.88, 95%CI: 0.80–0.97) self-care behavior reduced the odds of experiencing hyperglycemia. Hypoglycemia in type 1 DM was reduced by using CGM (AOR = 0.24, 95% CI: 0.09–0.60), while it was increased by experiencing a high diabetes self-management concern (AOR = 1.94, 95% CI: 1.04–3.61). Hyperglycemia in type 2 DM was increased by age (OR = 1.02, 95% CI: 1.00–1.04); high self-management concern (AOR = 2.59, 95% CI: 1.74–3.84); and poor confidence in self-management capacity (AOR = 3.22, 2.07–5.00). Conversely, diabetes app use (AOR = 0.63, 95% CI: 0.41–0.96) and “general diet” self-care (AOR = 0.84, 95% CI: 0.75–0.94), were significantly associated with the reduced odds of hyperglycemia. Conclusion: Diabetes apps, CGM, and educational interventions aimed at reducing self-management concerns and enhancing dietary self-care behavior and self-management confidence may help patients with diabetes to improve glycemic control.

Kebede M.M., Peters M., Heise T.L., Pischke C.R.

Kebede M.M., Zeeb H., Peters M., Heise T.L., Pischke C.R.

Digital interventions may assist patients with type 2 diabetes in improving glycemic control. We aimed to synthesize effect sizes of digital interventions on glycated hemoglobin (HbA1c) levels and to identify effective features of digital interventions targeting patients with poorly controlled type 2 diabetes.MEDLINE, ISI Web of Science, and PsycINFO were searched for randomized controlled trials (RCTs) comparing the effects of digital interventions with usual care. Two reviewers independently assessed studies for eligibility and determined study quality, using the Cochrane Risk of Bias Assessment Tool. The Behavioral Change Technique Taxonomy V1 (BCTTv1) was used to identify BCTs used in interventions. Mean HbA1c differences were pooled using analysis of covariance to adjust for baseline differences and pre-post correlations. To examine effective intervention features and to evaluate differences in effect sizes across groups, meta-regression and subgroup analyses were performed.Twenty-three arms of 21 RCTs were included in the meta-analysis (n = 3787 patients, 52.6% in intervention arms). The mean HbA1c baseline differences ranged from -0.2% to 0.64%. The pooled mean HbA1c change was statistically significant (-0.39 {95% CI: [-0.51 to -0.26]} with substantial heterogeneity [I2 statistic, 80.8%]) and a significant HbA1c reduction was noted for web-based interventions. A baseline HbA1c level above 7.5%, β = -0.44 (95% CI: [-0.81 to -0.06]), the BCTs "problem solving," β = -1.30 (95% CI: [-2.05 to -0.54]), and "self-monitoring outcomes of behavior," β = -1.21 (95% CI: [-1.95 to -0.46]) were significantly associated with reduced HbA1c levels.Digital interventions appear effective for reducing HbA1c levels in patients with poorly controlled type 2 diabetes.

Shin K.S., Lee E.

To examine the relationships of health literacy to diabetes self-care behaviors (diet, physical exercise, foot care and blood glucose monitoring) through empowerment controlling for diabetes education.Potential mechanisms of how health literacy links to health outcomes have not clearly elucidated.A cross-sectional study design was used.Participants were recruited from three community health centers in South Korea from September 2016 to April 2017 using a convenience sampling method. A total of 136 people with diabetes aged 60 and above were participated in this study. The main study variables of health literacy, empowerment and diabetes self-care activities were assessed using self-reported questionnaires. This study applied a simple mediation analysis with a single covariate using the PROCESS macro, with health literacy entered as an antecedent variable, empowerment as a mediator, diabetes self-care behaviors as outcome variables and diabetes education as a covariate.After controlling for diabetes education, the indirect effects of health literacy to self-care behaviors through empowerment were significant when the self-care behaviors were particularly diet and physical exercise. Whereas, the indirect effects were not significant when the self-care behaviors were foot care and blood glucose monitoring.This study indicates that the people with higher health literacy were more empowered and those with higher empowerment were more likely to eat healthy foods and exercise. In the light of these findings, a health literacy-tailored empowerment enhancing program may be important targets for interventions promoting diabetes self-care behaviors of diet and physical exercise.

Bonger Z., Shiferaw S., Tariku E.Z.

Self-care practices in diabetes patients are crucial to keep the illness under control and prevent complications. Effective management of diabetes will be a difficult task without adequate understanding of the existing level of practice related to diabetes self-care. This study is, therefore, aimed at assessing the self-care practice and its associated factors among patients with type 2 diabetes in Tikur Anbessa Specialized Hospital, Ethiopia.A health facility-based cross-sectional study was conducted among 419 type 2 diabetes patients from March 29, 2013, to May 16, 2013. The data were collected by face-to-face interview using structured and pretested questionnaire. Binary logistic regression was performed to assess the association between determinant factors and adherence to self-monitoring of blood glucose. Adjusted odds ratios (AOR) with its 95% confidence interval (CI) were estimated to identify factors associated with the outcome variables in the multivariable analysis.In this study, 318 (75.9%) diabetes patients did not adhere to the recommended diet management, 350 (83.5%) did not adhere to self-monitoring of blood glucose level, while 18 (4.3%) of the respondents did not adhere to the prescribed medications. Diabetic patients who were unemployed were 2.4 times more likely to practice blood glucose monitoring than merchants (AOR [95% CI] =2.4 [1.3-5.9]). Those who attended primary education were 70% less likely to adhere to blood glucose self-monitoring than those educated to a tertiary educational level (AOR [95% CI] =0.3 [0.1-0.9]). Respondents within the age group of 40-49 years were 11 times more likely to adhere to their medication than those aged 60-76 years (AOR [95% CI] =11 [1.03-13.6]).The study showed that the extent to which individuals adhere to the recommended management of type 2 diabetes is substantially low. Improving awareness of patients and the community at large is imperative especially on medication adherence, glycemic control and diet management.

Veazie S., Winchell K., Gilbert J., Paynter R., Ivlev I., Eden K.B., Nussbaum K., Weiskopf N., Guise J., Helfand M.

Patients with diabetes lack information on which commercially available applications (apps) improve diabetes-related outcomes. We conducted a rapid evidence review to examine features, clinical efficacy, and usability of apps for self-management of type 1 and type 2 diabetes in adults. Ovid/Medline and the Cochrane Database of Systematic Reviews were searched for systematic reviews and technology assessments. Reference lists of relevant systematic reviews were examined for primary studies. Additional searches for primary studies were conducted online, through Ovid/Medline, Embase, CINAHL, and ClinicalTrials.gov . Studies were evaluated for eligibility based on predetermined criteria, data were extracted, study quality was assessed using a risk of bias tool, information on app features was collected, and app usability was assessed. Results are summarized qualitatively. Fifteen articles evaluating 11 apps were identified: six apps for type 1 and five apps for type 2 diabetes. Common features of apps included setting reminders and tracking blood glucose and hemoglobin A1c (HbA1c), medication use, physical activity, and weight. Compared with controls, use of eight apps, when paired with support from a healthcare provider or study staff, improved at least one outcome, most often HbA1c. Patients did not experience improvements in quality of life, blood pressure, or weight, regardless of app used or type of diabetes. Study quality was variable. Of the eight apps available for usability testing, two were scored “acceptable,” three were “marginal,” and three were “not acceptable.” Limited evidence suggests that use of some commercially available apps, when combined with additional support from a healthcare provider or study staff, may improve some short-term diabetes-related outcomes. The impact of these apps on longer-term outcomes is unclear. More rigorous and longer-term studies of apps are needed. This review was funded by the Agency for Healthcare Research and Quality (AHRQ). The protocol is available at: http://www.effectivehealthcare.ahrq.gov/topics/diabetes-mobile-devices/research-protocol .

Veazie S., Winchell K., Gilbert J., Paynter R., Ivlev I., Eden K., Nussbaum K., Weiskopf N., Guise J., Helfand M.

Cho N.H., Shaw J.E., Karuranga S., Huang Y., da Rocha Fernandes J.D., Ohlrogge A.W., Malanda B.

Since the year 2000, IDF has been measuring the prevalence of diabetes nationally, regionally and globally.To produce estimates of the global burden of diabetes and its impact for 2017 and projections for 2045.A systematic literature review was conducted to identify published studies on the prevalence of diabetes, impaired glucose tolerance and hyperglycaemia in pregnancy in the period from 1990 to 2016. The highest quality studies on diabetes prevalence were selected for each country. A logistic regression model was used to generate age-specific prevalence estimates or each country. Estimates for countries without data were extrapolated from similar countries.It was estimated that in 2017 there are 451 million (age 18-99 years) people with diabetes worldwide. These figures were expected to increase to 693 million) by 2045. It was estimated that almost half of all people (49.7%) living with diabetes are undiagnosed. Moreover, there was an estimated 374 million people with impaired glucose tolerance (IGT) and it was projected that almost 21.3 million live births to women were affected by some form of hyperglycaemia in pregnancy. In 2017, approximately 5 million deaths worldwide were attributable to diabetes in the 20-99 years age range. The global healthcare expenditure on people with diabetes was estimated to be USD 850 billion in 2017.The new estimates of diabetes prevalence, deaths attributable to diabetes and healthcare expenditure due to diabetes present a large social, financial and health system burden across the world.

Husted G.R., Weis J., Teilmann G., Castensøe-Seidenfaden P.

Background: Adequate self-management is the cornerstone of preventing type 1 diabetes mellitus (T1DM) complications. However, T1DM self-management is challenging for young people, who often struggle during the transition from childhood to adulthood. The mobile health (mHealth) app Young with Diabetes (YWD) was developed in collaboration with young people to enhance their T1DM self-management during this transition. Objective: The purpose of this study was to explore the influence of YWD on young people’s self-management during a 12-month period. Methods: A qualitative explorative approach was used, comprising a purposive sample of 20 young people (11 females and 9 males, ages 15 to 23 years, with app use of 3 to 64 days) from 3 pediatric and 3 adult departments. Participants were interviewed individually using a semistructured interview guide. Data were collected from January to March 2017 and analyzed using thematic analysis. Results: A total of 5 themes were identified: (1) not feeling alone anymore (“we are in this together”); (2) gaining competence by sharing experiences and practical knowledge (“they know what they are talking about”); (3) feeling safer (“it’s just a click away”); (4) breaking the ice by starting to share thoughts and feelings and asking for help (“it is an outstretched hand”); and (5) lack of motivating factors (“done with the app”). Young people reported that YWD promoted self-management by peer-to-peer social support, exchanging messages with health care providers, and sharing YWD with parents. Participants recommended YWD as a supplement to self-management for newly diagnosed young people with T1DM and suggested improvements in app content and functionality. Conclusions: The mHealth app YWD has the potential to support self-management. In particular, peer-to-peer support reduced feelings of loneliness and helped young people to gain knowledge and skills for managing T1DM. A need exists for alternative ways to train health care providers in using YWD and to support collaboration between young people and their parents to further improve young people’s self-management of T1DM.

Lee D.Y., Park J., Choi D., Ahn H., Park S., Park C.

This randomized, controlled, open-label study conducted in Kangbuk Samsung Hospital evaluated the effectiveness, reproducibility, and durability of tailored mobile coaching (TMC) on diabetes management. The participants included 148 Korean adult policyholders with type 2 diabetes divided into the Intervention-Maintenance (I-M) group (n = 74) and Control-Intervention (C-I) group (n = 74). Intervention was the addition of TMC to typical diabetes care. In the 6-month phase 1, the I-M group received TMC, and the C-I group received their usual diabetes care. During the second 6-month phase 2, the C-I group received TMC, and the I-M group received only regular information messages. After the 6-month phase 1, a significant decrease (0.6%) in HbA1c levels compared with baseline values was observed in only the I-M group (from 8.1 ± 1.4% to 7.5 ± 1.1%, P < 0.001 based on a paired t-test). At the end of phase 2, HbA1c levels in the C-I group decreased by 0.6% compared with the value at 6 months (from 7.9 ± 1.5 to 7.3 ± 1.0, P < 0.001 based on a paired t-test). In the I-M group, no changes were observed. Both groups showed significant improvements in frequency of blood-glucose testing and exercise. In conclusion, addition of TMC to conventional treatment for diabetes improved glycemic control, and this effect was maintained without individualized message feedback.

Bommer C., Sagalova V., Heesemann E., Manne-Goehler J., Atun R., Bärnighausen T., Davies J., Vollmer S.

OBJECTIVE Despite the importance of diabetes for global health, the future economic consequences of the disease remain opaque. We forecast the full global costs of diabetes in adults through the year 2030 and predict the economic consequences of diabetes if global targets under the Sustainable Development Goals (SDG) and World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 are met. RESEARCH DESIGN AND METHODS We modeled the absolute and gross domestic product (GDP)-relative economic burden of diabetes in individuals aged 20–79 years using epidemiological and demographic data, as well as recent GDP forecasts for 180 countries. We assumed three scenarios: prevalence and mortality 1) increased only with urbanization and population aging (baseline scenario), 2) increased in line with previous trends (past trends scenario), and 3) achieved global targets (target scenario). RESULTS The absolute global economic burden will increase from U.S. $1.3 trillion (95% CI 1.3–1.4) in 2015 to $2.2 trillion (2.2–2.3) in the baseline, $2.5 trillion (2.4–2.6) in the past trends, and $2.1 trillion (2.1–2.2) in the target scenarios by 2030. This translates to an increase in costs as a share of global GDP from 1.8% (1.7–1.9) in 2015 to a maximum of 2.2% (2.1–2.2). CONCLUSIONS The global costs of diabetes and its consequences are large and will substantially increase by 2030. Even if countries meet international targets, the global economic burden will not decrease. Policy makers need to take urgent action to prepare health and social security systems to mitigate the effects of diabetes.

Alanzi T.

Background: Diabetes is a major health care burden in the Middle East region. Social networking tools can contribute to the management of diabetes with improved educational and care outcomes using these popular tools in the region. Objective: The objective of this review was to evaluate the impact of social networking interventions on the improvement of diabetes management and health outcomes in patients with diabetes in the Middle East. Methods: Peer-reviewed articles from PubMed (1990-2017) and Google Scholar (1990-2017) were identified using various combinations of predefined terms and search criteria. The main inclusion criterion consisted of the use of social networking apps on mobile phones as the primary intervention. Outcomes were grouped according to study design, type of diabetes, category of technological intervention, location, and sample size. Results: This review included 5 articles evaluating the use of social media tools in the management of diabetes in the Middle East. In most studies, the acceptance rate for the use of social networking to optimize the management of diabetes was relatively high. Diabetes-specific management tools such as the Saudi Arabia Networking for Aiding Diabetes and Diabetes Intelligent Management System for Iraq systems helped collect patient information and lower hemoglobin A1c (HbA1c) levels, respectively. Conclusions: The reviewed studies demonstrated the potential of social networking tools being adopted in regions in the Middle East to improve the management of diabetes. Future studies consisting of larger sample sizes spanning multiple regions would provide further insight into the use of social media for improving patient outcomes.

Ye Q., Khan U., Boren S.A., Simoes E.J., Kim M.S.

Background: Diabetes self-management (DSM) applications (apps) have been designed to improve knowledge of diabetes and self-management behaviors. However, few studies have systematically examined if diabetes apps followed the American Association of Diabetes Educators (AADE) Self-Care Behaviors™ guidelines. The purpose of this study was to compare the features of current DSM apps to the AADE7™ guidelines. Methods: In two major app stores (iTunes and Google Play), we used three search terms “diabetes,” “blood sugar,” and “glucose” to capture a wide range of diabetes apps. Apps were excluded based on five exclusion criteria. A multidisciplinary team analyzed and classified the features of each app based on the AADE7™. We conducted interviews with six diabetes physicians and educators for their opinions on the distribution of the features of DSM apps. Results: Out of 1050 apps retrieved, 173 apps were identified as eligible during November 2015 and 137 apps during December 2017. We found an unbalanced DSM app development trend based on AADE7™ guidelines. Many apps were designed to support the behaviors of Healthy Eating (77%), Monitoring (76%), Taking Medication (58%), and Being Active (45%). On the other hand, few apps explored the behaviors of Problem Solving (31%), Healthy Coping (10%), and Reducing Risks (5%). From interviews, we identified the main reasons why only a few apps support the features related to Problem Solving, Healthy Coping, and Reducing Risks. Conclusions: Future diabetes apps should attempt to incorporate features under evidence-based guidelines such as AADE7™ to better support the self-management behavior changes of people with diabetes.

Fan J., Li J., Duan C., Zhao Q., Guo Y.

Mobile health applications are increasingly acknowledged as effective instruments for enhancing self-management among individuals with diabetes. However, despite their potential, the extent of their global usage among this population remains unclear. To better understand this, we conducted a systematic review of existing studies to explore the worldwide usage of mobile health applications by this population and to identify factors that influence their usage. A total of 33 studies, involving 15 181 subjects, were analyzed. The findings indicated that, across the studies reviewed, the utilization rate of mobile health applications among individuals with diabetes was 25% (95% confidence interval, 20%-31%). Subgroup analyses demonstrated that country, education level, type of diabetes, mode of insulin delivery, and frequency of blood glucose monitoring influence the utilization rates of mobile health applications by this demographic. In addition, qualitative studies indicated that barriers to utilization, usability issues, the need for personalization, and social and infrastructure support also influence the use of mobile health applications by individuals with diabetes. In light of these influencing factors, policymakers, healthcare providers, and mobile health application developers should collaborate to develop effective strategies to increase the utilization rates of mobile health applications and improve diabetes management.

Gardner D.S., Saboo B., Kesavadev J., Mustafa N., Villa M., Mahoney E., Bajpai S.

Diabetes is a growing global health concern with a high prevalence in the Asian and Western Pacific regions. Effective diabetes management mainly relies on self-care practices. However, glycemic control remains poor, especially in developing nations where healthcare access is limited. Low physician density and minimal healthcare funding exacerbate the challenges faced by people with diabetes in Asia. Digital health technologies offer promising solutions to bridge these gaps. These technologies enhance patient engagement, improve medication adherence, and promote healthier lifestyles. Mobile apps provide tools for self-management, such as monitoring physical activity and dietary intake, while telemedicine platforms and electronic medical records facilitate patient data management and remote consultations. Despite the advantages provided by digital health technologies in managing diabetes, barriers to their adoption include infrastructure limitations, regulatory challenges, and issues with data security. Some Asian countries have made major strides in the adoption of digital health tools with national strategies and regulatory bodies to manage digital health options; however, disparities in digital health readiness persist. Effective implementation of these technologies requires addressing these barriers, including enhancing infrastructure, improving app usability, and ensuring regulatory compliance. While digital health solutions present significant opportunities, their impact depends on overcoming current challenges and ensuring equitable access and effective use in managing diabetes. Future directions should focus on prioritizing app acceptance and efficacy, as well as integrating machine learning and artificial intelligence-powered digital solutions.

Supramaniam P., Beh Y., Junus S., Devesahayam P.R.

Abstract Background Mobile health applications (mHealth apps) offer potential benefits for improving diabetes management, such as better glucose monitoring and patient engagement, but their widespread adoption faces challenges, including privacy concerns and user adherence. This research investigates mHealth app usage among patients living with diabetes in Kinta District, Perak, exploring experiences, challenges and patient perceptions regarding diabetes management using mHealth apps. Methodology A cross-sectional community survey was conducted in September till November 2020 across nine government health clinics focusing on diabetes mellitus (Type 1 or Type 2) patients, aged 18 years and older, receiving Diabetes Medication Adherence Counseling (DMTAC) services and able to use smart devices. A self-developed questionnaire with four sections was used to gather demographic information, explore mHealth apps usage and understand both users and non-users’ experiences and perceptions. The questionnaire was tested through cognitive debriefing, translated into Malay, pre-tested and finalized by the expert committee. The questionnaire was digitally implemented using Google® Form and QR code. After obtaining informed consent, data collection was performed by the trained DMTAC pharmacists. Statistical analyses involved descriptive and inferential analyses. Results The study analyzed the engagement of 295 patients living with diabetes with mHealth apps. Females (54.9%), of Malay ethnicity (58.3%) and with a mean age of 53.8 years (SD: 12.38) constituted the majority. Diabetes duration had a median of 6 years (IQR: 3.0, 10.0) with prevalent comorbidities like hypertension (58.0%) and dyslipidemia (42.7%). Most patients were employed (44.7%) and their primary source of diabetes management information was through healthcare providers (92.5%). Despite the high app use for social interaction, only 13.6% used mHealth apps for disease management. Users were influenced by social media (65.0%) and favored for wellness apps and disease monitoring. Users perceived the mHealth app as useful (97.5%), yet faced challenges over the app initiation, charges and data security. Non-users cited lack of awareness (70.2%), struggled with app startup (22.4%) and preference for conventional healthcare visits (22.0%). In multivariable analysis, longer diabetes duration reduced mHealth app usage (p = 0.046), while multimorbidity increased the likelihood (p = 0.001). Awareness of the availability of health apps significantly influenced the usage of mHealth apps (p < 0.001). Conclusion The findings highlight the underutilization of mHealth apps for diabetes management despite their perceived usefulness. Challenges faced by users and non-users underscore the need for more awareness, thus encourage widespread acceptance and usage of mHealth apps in diabetes care.

Alvarez S., Fellas A., Wynne K., Santos D., Sculley D., Acharya S., Navathe P., Girones X., Coda A.

Abstract Background The use of smart technology in the management of all forms of diabetes mellitus has grown significantly in the past 10 years. Technologies such as the smartwatch have been proposed as a method of assisting in the monitoring of blood glucose levels as well as other alert prompts such as medication adherence and daily physical activity targets. These important outcomes reach across all forms of diabetes and have the potential to increase compliance of self-monitoring with the aim of improving long-term outcomes such as hemoglobin A1c (HbA1c). Objective This systematic review aims to explore the literature for evidence of smartwatch technology in type 1, 2, and gestational diabetes. Methods A systematic review was undertaken by searching Ovid MEDLINE and CINAHL databases. A second search using all identified keywords and index terms was performed on Ovid MEDLINE (January 1966 to August 2023), Embase (January 1980 to August 2023), Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, latest issue), CINAHL (from 1982), IEEE Xplore, ACM Digital Libraries, and Web of Science databases. Type 1, type 2, and gestational diabetes were eligible for inclusion. Quantitative studies such as prospective cohort or randomized clinical trials that explored the feasibility, usability, or effect of smartwatch technology in people with diabetes were eligible. Outcomes of interest were changes in blood glucose or HbA1c, physical activity levels, medication adherence, and feasibility or usability scores. Results Of the 8558 titles and abstracts screened, 5 studies were included for qualitative synthesis in this review. A total of 322 participants with either type 1 or type 2 diabetes mellitus were included in the review. A total of 4 studies focused on the feasibility and usability of smartwatch technology in diabetes management. One study conducted a proof-of-concept randomized clinical trial including smartwatch technology for exercise time prescriptions for participants with type 2 diabetes mellitus. Adherence of participants to smartwatch technology varied between included studies, with one reporting input submissions of 58% and another reporting that participants logged 50% more entries than they were required to. One study reported significantly improved glycemic control with integrated smartwatch technology, with increased exercise prescriptions; however, this study was not powered and required a longer observational period. Conclusions This systematic review has highlighted the lack of robust randomized clinical trials that explore the efficacy of smartwatch technology in the management of patients with type 1, type 2, and gestational diabetes. Further research is required to establish the role of integrated smartwatch technology in important outcomes such as glycemic control, exercise participation, drug adherence, and diet monitoring in people with all forms of diabetes mellitus.

Murrin E.M., Saad A.F., Sullivan S., Millo Y., Miodovnik M.

Pregnancies impacted by diabetes face the compounded challenge of strict glycemic control with mounting insulin resistance as the pregnancy progresses. New technological advances, including artificial intelligence (AI) and the Internet of Medical Things (IoMT), are revolutionizing health care delivery by providing innovative solutions for diabetes care during pregnancy. Together, AI and the IoMT are a multibillion-dollar industry that integrates advanced medical devices and sensors into a connected network that enables continuous monitoring of glucose levels. AI-driven clinical decision support systems (CDSSs) can predict glucose trends and provide tailored evidence-based treatments with real-time adjustments as insulin resistance changes with placental growth. Additionally, mobile health (mHealth) applications facilitate patient education and self-management through real-time tracking of diet, physical activity, and glucose levels. Remote monitoring capabilities are particularly beneficial for pregnant persons with diabetes as they extend quality care to underserved populations and reduce the need for frequent in-person visits. This high-resolution monitoring allows physicians and patients access to an unprecedented wealth of data to make more informed decisions based on real-time data, reducing complications for both the mother and fetus. These technologies can potentially improve maternal and fetal outcomes by enabling timely, individualized interventions based on personalized health data. While AI and IoMT offer significant promise in enhancing diabetes care for improved maternal and fetal outcomes, their implementation must address challenges such as data security, cost-effectiveness, and preserving the essential patient–provider relationship. Key Points

Birhanu T.E., Guracho Y.D., Asmare S.W., Olana D.D.

BackgroundMobile health technologies are increasingly acknowledged as a cost-effective and convenient means of delivering top-notch healthcare services to patients in low- and middle-income countries. This research explores the utilization of mobile health applications in managing, monitoring, and self-care for adult diabetes mellitus (DM) patients. The objective is to gain insight into how diabetic patients currently utilize Mobile health applications for self-management and their inclination to use them in the future.MethodsThe authors conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. They included articles that reported on the use of mobile/smartphone applications for diabetic mellitus disorders, focusing on ownership, application use, future interest in use, and use patterns. The search was conducted in the PubMed, Web of Science, Embase, and SCOPUS electronic databases, with various published articles from January 2016 up to February 2024. The methodological quality was evaluated using the Joanna Briggs Institute critical appraisal tool. Statistical techniques were applied, including the heterogeneity test, publication bias assessment, Egger’s test, and funnel plots. The pooled prevalence was calculated using meta-analysis proportion with a random-effects model.ResultsThirteen studies were included, out of 4568 recognized articles. The pooled prevalence of mobile health application use for current diabetic management self-management, future interest in using the application for diabetic disorder self-management, and lack of belief in mobile health application users for self-management was 35%, 57%, and 39%, respectively. We observed significant heterogeneity (I2 = 97.7, p=&lt;0.001), but no significant publication bias was detected on Egger’s test.ConclusionsOur meta-analysis results show that over one-third of individuals use mobile health applications for diabetic self-management, and more than half of individuals would like to manage their diabetes mellitus in the future by using mobile health applications. These mobile health apps may be promising in future diabetes mellitus self-management. However, we still need to study the effectiveness of these apps. In addition, adopting mobile health apps based on the cultural context makes this self-management more achievable, practical, and impactful for individuals with diabetes.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier 42024537917.

Trombini R.R., Dusi R., Pereira A.L., Zandonadi R.P., Stival M.M., Ginani V.C., Funghetto S.S.

Background: Digital educational technologies in health have been an important instrument for promoting learning, self-care, self-esteem, and security regarding prevention and health promotion actions that lead to changes in behavior, mainly for non-communicable disease patients, such as type 2 Diabetes Mellitus (DM 2). Objective: This study aimed to describe a protocol for evaluating the effect of an app for cell phones and tablets on the blood glucose of older adults with DM 2. Methods: The protocol will be used to compare the effectiveness of an application for mobile devices concerning the educational booklet in reducing Glycated Hemoglobin in older adults with DM 2 in Primary Health Care. This protocol is part of a Randomized Clinical Trial project entitled Effectiveness of a Mobile Device Application on Glycated Hemoglobin in Elderly People with Type 2 Diabetes Mellitus: a Randomized Clinical Trial. Results: The protocol was structured in the following phases: (i) sample calculation, (ii) invitation to participate in the study according to the eligibility criteria; (iii) participant registration; (iv) randomization and allocation of participants into groups (double blinding); (v) application of the intervention; (vi) post-intervention procedures (post-test); (vii) data analysis. Conclusion: It is expected that encouraging studies on the impact of a mobile application will improve and enhance health education focused on self-care for older adults with DM 2, potentially influencing the local health system by reducing hospitalizations due to conditions that are sensitive to primary care, since health promotion and prevention of DM-related illnesses will be the main focus of the application and booklet developed.

Yaagoob E., Lee R., Stubbs M., Hakami M., Chan S.

AbstractRationalOnline Diabetes Self‐Management Education and Support (DSMES) offers people with type 2 diabetes mellitus (T2DM) accessible and tailored education, utilising innovative and interactive tools such as social media to enhance engagement and outcomes. Despite the demonstrated effectiveness of social media‐based DSMES in improving health outcomes, there remains a significant gap in qualitative insights regarding participants' experiences.AimThis study aims to explore the experiences of people with T2DM who are using a newly developed WhatsApp‐based DSMES.MethodsA qualitative descriptive approach was adopted. Data consisted of 23 semi‐structured phone interviews with people with T2DM who had received the WhatsApp‐based DSMES. Interviews were analysed using qualitative content analysis. The present study adheres to the COREQ guidelines.ResultsFour themes emerged from the data: (1) acceptability of the programme, (2) flexible accessibility of the programme, (3) promoting healthy lifestyle and (4) future preferences for the programme use.ConclusionThis study explored the experiences of people with T2DM participating in a 6‐week WhatsApp‐based DSMES. The findings indicated that the programme was acceptable, accessible, effectively revealing necessary self‐management knowledge and skills, and provided essential support from professional and peer. The study also indicated that WhatsApp‐based programmes could be feasibly implemented in various populations, healthcare settings and communities to support people with T2DM globally.

Mitchell E.G., Mamykina L.

Lubasinski N., Thabit H., Nutter P.W., Harper S.

Introduction: Type 1 Diabetes (T1D) presents self-management challenges, requiring an additional 180 daily decisions to regulate blood glucose (BG) levels. Despite the potential, T1D-focused applications have a 43% attrition rate. This work delves into the willingness of people living with T1D (PwT1D) to use technology. Method: An online questionnaire investigated the current practices for carbohydrate estimation, nutritional tracking, and attitudes towards technology engagement, along with hypothetical scenarios and preferences regarding technology use. Results: Thirty-nine responses were collected from PwT1D (n = 33) and caregivers (n = 6). Nutrition reporting preferences varied, with 50% favoring ‘type and scroll’ while 30% preferred meal photographing. Concerning the timing of reporting, 33% reported before meals, 55% after, and 12% at a later time. Improved Time in Range (TIR) was a strong motivator for app use, with 78% expressing readiness to adjust insulin doses based on app suggestions for optimizing TIR. Meal descriptions varied; a single word was used in 42% of cases, 23% used a simple description (i.e., “Sunday dinner”), 30% included portion sizes, and 8% provided full recipes. Conclusion: PwT1D shows interest in using technology to reduce the diabetes burden when it leads to an improved TIR. For such technology to be ecologically valid, it needs to strike a balance between requiring minimal user input and providing significant data, such as meal tags, to ensure accurate blood glucose management without overwhelming users with reporting tasks.

Nagy M., Simon B., Szász L., Siket M., Dénes-Fazakas L., Eigner G., Süli P.P., Kovács L., Szilágyi L.

Pala D., Petrini G., Bosoni P., Larizza C., Quaglini S., Lanzola G.

A proper nutrition is essential for human life. Recently, special attention on this topic has been given in relation to three health statuses: obesity, malnutrition and specific diseases that can be related to food or treated with specific diets. Mobile technology is often used to assist users that wish to regulate their eating habits, and identifying which fields of application have been explored the most by the app developers and which main functionalities have been adopted can be useful in view of future app developments.We selected 322 articles mentioning nutrition support apps through a literature database search, all of which have undergone an initial screening. After the exclusion of papers that were already reviews, not presenting apps or not focused on nutrition, not relevant or not developed for human subjects, 100 papers were selected for subsequent analyses that aimed at identifying the main treated conditions, outcome measures and functionalities implemented in the Apps.Of the selected studies, 33 focus on specific diseases, 24 on obesity, 2 on malnutrition and 41 on other targets (e.g., weight/diet control). Type 2 diabetes is the most targeted disease, followed by gestational diabetes, hypertension, colorectal cancer and CVDs which all were targeted by more than one app. Most Apps include self-monitoring and coaching functionalities, educational content and artificial intelligence (AI) tools are slightly less common, whereas counseling, gamification and questionnaires are the least implemented. Body weight and calories/nutrients were the most common general outcome measures, while glycated hemoglobin (HbA1c) was the most common clinical outcome. No statistically significant differences in the effectiveness of the different functionalities were found.The use of mobile technology to improve nutrition has been widely explored in the last years, especially for weight control and specific diseases like diabetes; however, other food-related conditions such as Irritable Bowel Diseases appear to be less targeted by newly developed smartphone apps and their related studies. All different kinds of functionalities appear to be equally effective, but further specific studies are needed to confirm the results.

Chandran S.R., Ho C., Yeoh E., Gardner D.

Abstract Introduction: To describe the self-care challenges, diabetes technology awareness, current use, and satisfaction among adults with type 1 diabetes and parents of children with type 1 diabetes in Singapore. Methods: An anonymous online survey was administered between November 2020 and October 2021. Data are presented as mean (standard deviation) or count (percentages). Comparisons between groups were done using the independent samples T-test. Results: 251 people (176 adults, 75 parents) participated. The most challenging self-care burdens were carbohydrate counting (24.4%) among adults and insulin dose calculations (28%) among parents. Nocturnal awakenings for diabetes care of their child were a common event (25.3%). Despite high awareness about continuous glucose monitoring devices (77.8% adults, 78.7% parents) the use (24.9% adults, 55% children) remained low. Both adults and parents of children with type 1 diabetes found continuous glucose monitoring to be liberating and less restrictive. Despite overall low insulin pump use (23.9% adults, 29.3% children); satisfaction scores were higher among insulin pump users than insulin pen users (P = 0.02). Conclusion: Carbohydrate counting and insulin dose calculations were the most challenging self-care tasks among people with type 1 diabetes in Singapore. Diabetes technology use was relatively low in Singapore. Continuous glucose monitoring and Insulin pump users found them to be beneficial.

McClure R.D., Talbo M.K., Bonhoure A., Molveau J., South C.A., Lebbar M., Wu Z.

Maintaining positive health behaviours promotes better health outcomes for people with type 1 diabetes (T1D). However, implementing these behaviours may also lead to additional management burdens and challenges. Diabetes technologies, including continuous glucose monitoring systems, automated insulin delivery systems, and digital platforms, are being rapidly developed and widely used to reduce these burdens. Our aim was to review recent evidence to explore the influence of these technologies on health behaviours and well-being among adults with T1D and discuss future directions. Current evidence, albeit limited, suggests that technologies applied in diabetes self-management education and support (DSME/S), nutrition, physical activity (PA), and psychosocial care areas improved glucose outcomes. They may also increase flexibility in insulin adjustment and eating behaviours, reduce carb counting burden, increase confidence in PA, and reduce mental burden. Technologies have the potential to promote health behaviours changes and well-being for people with T1D. More confirmative studies on their effectiveness and safety are needed to ensure optimal integration in standard care practices.

Maleki M., Mardani A., Iloonkashkooli R., Khachian A., Glarcher M., Vaismoradi M.

ObjectivesGiven the increasing trend of care transition from healthcare settings to patients’ own home, patients and their family caregivers should take more responsibilities for care at own home. This study is going to investigate the effect of a transitional care program from hospital to own home using a digital messaging application on patients’ undergoing coronary artery bypass graft (CABG) surgery and their family caregivers’ health outcomes.MethodsA parallel randomized controlled trial study will be conducted in a hospital in a metropolis located in southwestern Iran. Sampling will be performed sequentially and the eligible dyad of patients and family caregivers will be randomly assigned to intervention and control groups. The intervention group will receive a transitional care program for 8 weeks using the WhatsApp on the mobile phone based on the person-centered care approach, but the control group will receive routine care for patient’s transition. Data collection will be conducted at baseline, immediately after the intervention, and two months after the intervention using demographic questionnaire, Cardiac Self-Efficacy Scale (CSES), MacNew Heart Disease Health-Related Quality of Life questionnaire (MNHD-Q), Cardiac Symptom Scale (CSS), Morisky Medication Adherence Scale, and Caregiver Burden Scale (CBS). Descriptive and inferential statistics will be used for data analysis.ConclusionsThe results of this study will allow evaluating the effectiveness of an innovative transitional care program to patients’ own home using a digital messaging application. If the transitional program is shown feasible and effective it can be incorporated into existing care programs and stimulate further studies on the use of digital solutions for improving the continuity of care in own home.