T2DM Self-Management via Smartphone Applications: A Systematic Review and Meta-Analysis

Health and Nutrition Promotion Programs in Papua New Guinea: A Scoping Review

There is a rising prevalence of non-communicable diseases (NCDs) in Papua New Guinea (PNG), adding to the disease burden from communicable infectious diseases and thus increasing the burden on the healthcare system in a low-resource setting. The aim of this review was to identify health and nutrition promotion programs conducted in PNG and the enablers and barriers to these programs. Four electronic databases and grey literature were searched. Two reviewers completed screening and data extraction. This review included 23 papers evaluating 22 health and nutrition promotion programs, which focused on the Ottawa Charter action areas of developing personal skills (12 programs), reorienting health services (12 programs) and strengthening community action (6 programs). Nineteen programs targeted communicable diseases; two addressed NCDs, and one addressed health services. Enablers of health promotion programs in PNG included community involvement, cultural appropriateness, strong leadership, and the use of mobile health technologies for the decentralisation of health services. Barriers included limited resources and funding and a lack of central leadership to drive ongoing implementation. There is an urgent need for health and nutrition promotion programs targeting NCDs and their modifiable risk factors, as well as longitudinal study designs for the evaluation of long-term impact and program sustainability.

Wearable monitoring device based on an internet management platform improves metabolic parameters in type 2 diabetes patients: a prospective pilot study

OBJECTIVES

This pilot study aimed to prospectively investigate the effects of a wearable monitoring device, based on an Internet management platform, on the comprehensive management of type 2 diabetes mellitus (T2DM) patients.

METHODS

A total of 120 hospitalized patients with T2DM were enrolled and randomly divided into the control group and the intervention group. Patients in the control group only received conventional diabetes treatments, while patients in the intervention group were provided with a wearable monitoring device in addition to conventional diabetes treatments. Moreover, the wearable device could connect to an Internet platform for diabetes management and upload self-monitoring data. All patients were followed for 3 months. The changes in parameters representing glucose metabolism, blood lipids, renal function, and patient satisfaction were compared between the two groups. All results were analyzed on an intention-to-treat basis.

RESULTS

One hundred twenty subjects met all criteria and agreed to participate in this study. During the follow-up period, 5 and 4 subjects were lost to follow-up in the intervention and control groups, respectively. Compared with the control group, the blood glucose of the intervention group decreased significantly after 3 months (p < 0.05). Subgroup analysis found that females, those younger than 60 years, with baseline glycated hemoglobin A1c (HbA1c) levels of 8% or greater, and patients with good adherence showed significant improvements in HbA1c (p < 0.05). However, there was no significant difference in blood lipid and renal function. The intervention group showed a better adherence rate to blood glucose, comprehensive adherence rate, and diabetes treatment satisfaction (p < 0.05). One subject in the intervention group and two subjects in the control group reported mild hypoglycemia. No other adverse events such as infections and skin allergies occurred in the two groups.

CONCLUSION

The intervention of a wearable monitoring device based on an Internet management platform significantly improved blood glucose control in T2DM patients, as well as the overall adherence rate and patient satisfaction with treatment.

CLINICAL TRIAL REGISTRATION

NCT04973644.

Effectiveness of DialBetesPlus, a self-management support system for diabetic kidney disease: Randomized controlled trial

We evaluated the effectiveness of a mobile health (mHealth) intervention for diabetic kidney disease patients by conducting a 12-month randomized controlled trial among 126 type 2 diabetes mellitus patients with moderately increased albuminuria (urinary albumin-to-creatinine ratio (UACR): 30-299 mg/g creatinine) recruited from eight clinical sites in Japan. Using a Theory of Planned Behavior (TPB) behavior change theory framework, the intervention provides patients detailed information in order to improve patient control over exercise and dietary behaviors. In addition to standard care, the intervention group received DialBetesPlus, a self-management support system allowing patients to monitor exercise, blood glucose, diet, blood pressure, and body weight via a smartphone application. The primary outcome, change in UACR after 12 months (used as a surrogate measure of renal function), was 28.8% better than the control group's change (P = 0.029). Secondary outcomes also improved in the intervention group, including a 0.32-point better change in HbA1c percentage (P = 0.041). These improvements persisted when models were adjusted to account for the impacts of coadministration of drugs targeting albuminuria (GLP-1 receptor agonists, SGLT-2 inhibitors, ACE inhibitors, and ARBs) (UACR: -32.3% [95% CI: -49.2%, -9.8%] between-group difference in change, P = 0.008). Exploratory multivariate regression analysis suggests that the improvements were primarily due to levels of exercise. This is the first trial to show that a lifestyle intervention via mHealth achieved a clinically-significant improvement in moderately increased albuminuria.

Optimizing type 2 diabetes management: AI-enhanced time series analysis of continuous glucose monitoring data for personalized dietary intervention

Despite advanced health facilities in many developed countries, diabetic patients face multifold health challenges. Type 2 diabetes mellitus (T2DM) go along with conspicuous symptoms due to frequent peaks, hypoglycemia <=70 mg/dL (while fasting), or hyperglycemia >=180 mg/dL two hours postprandial, according to the American Diabetes Association (ADA)). The worse effects of Type 2 diabetes mellitus are precisely associated with the poor lifestyle adopted by patients. In particular, a healthy diet and nutritious food are the key to success for such patients. This study was done to help T2DM patients improve their health by developing a favorable lifestyle under an AI-assisted Continuous glucose monitoring (CGM) digital system. This study aims to reduce the blood glucose level fluctuations of such patients by rectifying their daily diet and maintaining their exertion vs. food consumption records. In this study, a well-precise prediction is obtained by training the ML model on a dataset recorded from CGM sensor devices attached to T2DM patients under observation. As the data obtained from the CGM sensor is time series, to predict blood glucose levels, the time series analysis and forecasting are done with XGBoost, SARIMA, and Prophet. The results of different Models are then compared based on performance metrics. This helped in monitoring various trends, specifically irregular patterns of the patient's glucose data, collected by the CGM sensor. Later, keeping track of these trends and seasonality, the diet is adjusted accordingly by adding or removing particular food and keeping track of its nutrients with the intervention of a commercially available all-in-one AI solution for food recognition. This created an interactive assistive system, where the predicted results are compared to food contents to bring the blood glucose levels within the normal range for maintaining a healthy lifestyle and to alert about blood glucose fluctuations before the time that are going to occur sooner. This study will help T2DM patients get in managing diabetes and ultimately bring HbA1c within the normal range (<= 5.7%) for diabetic and pre-diabetic patients, three months after the intervention.

Which behaviour change techniques work best for diabetes self-management mobile apps? Results from a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Self-management is pivotal in addressing noncommunicable diseases, such as diabetes. The increased availability of digital behaviour change interventions (DBCIs) delivered through mobile health apps offers unprecedented opportunities to enhance self-management and improve health outcomes. However, little is known about the characteristics of DBCIs for diabetes that significantly impact glycaemic control. Therefore, our systematic review with meta-analysis aimed to summarize characteristics and behaviour change components in DBCIs for diabetes self-management and explore potential associations with metabolic outcomes.

METHODS

A systematic search was conducted in PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Scopus to identify randomized controlled trials published until November 2023. The main outcome variable was the change in the mean difference of HbA1c levels between baseline and follow-up across intervention and control groups. Random-effects meta-regression was used to explore variation in glycaemic control as a function of prespecified characteristics of study designs and app interventions.

FINDINGS

A total of 57 studies was included in the analysis, showing a statistically significant percentage point reduction in HbA1c for the intervention group compared to the control arm (-0.36, 95% CI = -0.46 to -0.26, p < 0.001). The inclusion of "self-monitoring of behaviour" as a behaviour change technique (β = -0.22, p = 0.04) and "taking medication" as a target behaviour (β = -0.20, p = 0.05) was associated with improved metabolic outcomes.

INTERPRETATION

Our analyses endorse the use of diabetes self-management apps, highlighting characteristics statistically associated with intervention effectiveness and guiding the design of more effective DBCIs.

FUNDING

This project received funding from the European Union's Horizon 2020 programme.

Effectiveness of technology-based psychosocial interventions on diabetes distress and health-relevant outcomes among type 2 diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

Poor management of type 2 diabetes mellitus may affect individuals' physical and emotional health. Access to ongoing psychosocial interventions through technological platforms may potentially minimise diabetes complications and improve health-related outcomes. However, little is known about the effectiveness of such interventions on diabetes distress and health-related outcomes.

OBJECTIVE

To synthesise the best available evidence concerning the effectiveness of technology-based psychosocial interventions on diabetes distress, self-efficacy, health-related quality of life, and HbA1c level in adults with type 2 diabetes mellitus.

METHODS

A search of eleven databases was conducted to identify randomised controlled trials that examined the effects of technology-based psychosocial interventions on the outcomes. Randomised controlled trials reported in English from 2010 to 2020 were included. Selection of studies, quality appraisal, and data extraction were conducted by two reviewers independently. Meta-analyses, subgroup analyses and sensitivity analysis were performed using Review Manager. Intervention effects was measured using standardise mean difference.

RESULTS

Twenty randomised controlled trials fulfilled the eligibility criteria and 18 randomised controlled trials were included in meta-analysis. technology-based psychosocial interventions improved diabetes distress, self-efficacy and HbA1c levels with significant and small effect sizes. Subgroup analyses revealed greater improvement in health-related quality of life for participants with comorbid depression and lower HbA1c levels for studies with lesser than 100 participants.

CONCLUSION

The findings of this review increase knowledge on the effectiveness of technology-based psychosocial interventions on diabetes distress and self-efficacy. However, evidence to support the effects of technology-based psychosocial interventions on HbA1c and health-related quality of life was not strong. More research is needed to examine the effectiveness of the psychosocial interventions delivered through mobile applications or virtual reality.

The effect of self-management intervention among type 2 diabetes: A systematic review and meta-analysis

BACKGROUND

Using self-management interventions in type 2 diabetes care helps to regulate blood sugar levels, reduce caregiver burden, improve health outcomes, and improve expense management. Despite these benefits, the efficacy of self-management interventions for type 2 diabetes care remains uncertain, with studies showing inconclusive results that are open to interpretation.

AIMS

The aim of this systematic review and meta-analysis was to examine the available data to determine the effectiveness of self-management strategies for individuals with type 2 diabetes.

METHODS

The search method was restricted to the Cumulative Index to Nursing and Allied Health Literature, PubMed, ProQuest, Science Direct, and Scopus from January 2012 to December 2022. SPSS version 28 was used for the meta-analysis.

RESULTS

Seven studies fulfilled the eligibility criteria, with 697 individuals with type 2 diabetes included. Six papers were designed as randomized control trials and one as a quasi-experimental study. Meta-analysis showed a significant difference between the self-management and control groups, with a standardized mean difference (Cohen's d) of -0.40, (95% confidence interval [-0.60 to -0.20]), p = .00.

LINKING EVIDENCE TO ACTION

This meta-analysis showed that self-management interventions in type 2 diabetes patients successfully reduced HbA1c. Self-management improves type 2 diabetes treatment by helping people stay healthy and adapt to their illnesses.

Health Outcomes Following Engagement With a Digital Health Tool Among People With Prediabetes and Type 2 Diabetes: Prospective Evaluation Study

BACKGROUND

Diabetes is a worldwide chronic condition causing morbidity and mortality, with a growing economic burden on health care systems. Complications from poorly controlled diabetes are associated with increased socioeconomic costs and reduced quality of life. Smartphones have become an influential platform, providing feasible tools such as health apps to deliver tailored support to enhance the ability of patients with diabetes for self-management. Gro Health is a National Health Service division X-certified digital health tool used to deliver educational and monitoring support to facilitate the development of skills and practices for maintaining good health.

OBJECTIVE

This study aims to assess self-reported outcomes of the Gro Health app among users with diabetes and prediabetes and identify the factors that determine engagement with the digital health tool.

METHODS

This was a service evaluation of self-reported data collected prospectively by the developers of the Gro Health app. The EQ-5D questionnaire is a standardized tool used to measure health status for clinical and economic appraisal. Gro Health users completed the EQ-5D at baseline and 6 months after using the app. Users provided informed consent for the use of their anonymized data for research purposes. EQ-5D index scores and visual analogue scale (VAS) scores were calculated at baseline and 6 months for individuals with prediabetes and type 2 diabetes. Descriptive statistics and multiple-regression models were used to assess changes in the outcome measures and determine factors that affected engagement with the digital tool.

RESULTS

A total of 84% (1767/2114) of Gro Health participants completed EQ-5D at baseline and 6 months. EQ-5D index scores are average values that reflect people's preferences about their health state (1=full health and 0=moribund). There was a significant and clinically meaningful increase in mean EQ-5D index scores among app users between baseline (0.746, SD 0.23) and follow-up (0.792, SD 0.22; P<.001). The greatest change was observed in the mean VAS score, with a percentage change of 18.3% improvement (61.7, SD 18.1 at baseline; 73.0, SD 18.8 at follow-up; P<.001). Baseline EQ-5D index scores, age, and completion of educational modules were associated with significant changes in the follow-up EQ-5D index scores, with baseline EQ-5D index scores, race and ethnicity, and completion of educational modules being significantly associated with app engagement (P<.001).

CONCLUSIONS

This study provides evidence of a significant positive effect on self-reported quality of life among people living with type 2 diabetes engaging with a digital health intervention. The improvements, as demonstrated by the EQ-5D questionnaire, are facilitated through access to education and monitoring support tools within the app. This provides an opportunity for health care professionals to incorporate National Health Service-certified digital tools, such as Gro Health, as part of the holistic management of people living with diabetes.

An umbrella review of effectiveness and efficacy trials for app-based health interventions

Health interventions based on mobile phone or tablet applications (apps) are promising tools to help patients manage their conditions more effectively. Evidence from randomized controlled trials (RCTs) on efficacy and effectiveness of such interventions is increasingly available. This umbrella review aimed at mapping and narratively summarizing published systematic reviews on efficacy and effectiveness of mobile app-based health interventions within patient populations. We followed a pre-specified publicly available protocol. Systematic reviews were searched in two databases from inception until August 28, 2023. Reviews that included RCTs evaluating integrated or stand-alone health app interventions in patient populations with regard to efficacy/effectiveness were considered eligible. Information on indications, outcomes, app characteristics, efficacy/effectiveness results and authors' conclusions was extracted. Methodological quality was assessed using the AMSTAR2 tool. We identified 48 systematic reviews published between 2013 and 2023 (35 with meta-analyses) that met our inclusion criteria. Eleven reviews included a broad spectrum of conditions, thirteen focused on diabetes, five on anxiety and/or depression, and others on various other indications. Reported outcomes ranged from medication adherence to laboratory, anthropometric and functional parameters, symptom scores and quality of life. Fourty-one reviews concluded that health apps may be effective in improving health outcomes. We rated one review as moderate quality. Here we report that the synthesized evidence on health app effectiveness varies largely between indications. Future RCTs should consider reporting behavioral (process) outcomes and measures of healthcare resource utilization to provide deeper insights on mechanisms that make health apps effective, and further elucidate their impact on healthcare systems.

The effect of personalized intelligent digital systems for self-care training on type II diabetes: a systematic review and meta-analysis of clinical trials

AIMS

Type 2 diabetes (T2D) is rising worldwide. Self-care prevents diabetic complications. Lack of knowledge is one reason patients fail at self-care. Intelligent digital health (IDH) solutions have a promising role in training self-care behaviors based on patients' needs. This study reviews the effects of RCTs offering individualized self-care training systems for T2D patients.

METHODS

PubMed, Web of Science, Scopus, Cochrane Library, and Science Direct databases were searched. The included RCTs provided data-driven, individualized self-care training advice for T2D patients. Due to the repeated studies measurements, an all-time-points meta-analysis was conducted to analyze the trends over time. The revised Cochrane risk-of-bias tool (RoB 2.0) was used for quality assessment.

RESULTS

In total, 22 trials met the inclusion criteria, and 19 studies with 3071 participants were included in the meta-analysis. IDH interventions led to a significant reduction of HbA1c level in the intervention group at short-term (in the third month: SMD = - 0.224 with 95% CI - 0.319 to - 0.129, p value < 0.0; in the sixth month: SMD = - 0.548 with 95% CI - 0.860 to - 0.237, p value < 0.05). The difference in HbA1c reduction between groups varied based on patients' age and technological forms of IDH services delivery. The descriptive results confirmed the impact of M-Health technologies in improving HbA1c levels.

CONCLUSIONS

IDH systems had significant and small effects on HbA1c reduction in T2D patients. IDH interventions' impact needs long-term RCTs. This review will help diabetic clinicians, self-care training system developers, and researchers interested in using IDH solutions to empower T2D patients.

The diabetes education material on diabetes for website: Results of a validation process

OBJECTIVE

To validate an educational material on diabetes through an expert consensus for its implementation into a web site.

MATERIAL AND METHODS

An observational study was carried out in a group of health professionals, for which an educational material was developed for patients with diabetes. Topics included nutrition, physical exercise, control indicators, complications, pharmacological treatment, among others. The language, text and figures were focused on easy comprehension, additionally, a section of didactic activities to be answered by the patient with diabetes at the end of each module was included. To evaluate the educational material by health professionals, an instrument was designed and validated. Once all the educational material was available, each of the modules was sent by e-mail to at least three clinical experts in the assigned topic, as well as the instrument for the evaluation of the module.

RESULTS

Thirty-seven experts were included in the study, 76% rated the educational modules evaluated as highly adequate, while only 24% rated them as adequate. The instrument used obtained a good level of internal consistency, with a Cronbach's alpha coefficient of 0.92. In the dimensions of the instrument, the lowest Cronbach's alpha score was that of "call-to-action", with a value of 0.71.

CONCLUSION

The diabetes educational material was rated as highly appropriate by the clinical experts. The developed instrument has an adequate content validity, as well as a good level of internal consistency.

The effect of using mobile health on self-management of type 2 diabetic patients: A systematic review in Iran

Type 2 diabetes, as one of the most common chronic diseases, requires ongoing management and support from the patient; therefore, patient participation and self-management play a pivotal role in controlling and preventing this disease. The increasing use of smartphones has provided a good opportunity for controlling and managing patients with type 2 diabetes. This study aimed to investigate the effect of mobile health on the self-management of patients with type 2 diabetes in Iran. A systematic review study was conducted from 2010 to 2021. Searches in Persian and English scientific databases, IranDoc, MagIran, SID Web of science, and PubMed, were performed using keywords such as diabetes and mobile health. The process of reviewing and selecting articles based on inclusion and exclusion criteria was performed by two researchers independently. The study evaluation was performed by using a standard tool. After selecting articles, data extraction was performed using a data extraction form. Data analysis was performed with a content analysis approach. Finally, 23 articles were included from the 7767 articles found in the initial search stage, which examined patients' self-care in 11 areas using mobile health. Fourteen studies (61%) considered mobile health to be effective in increasing hemoglobin control. Other studies also found the use of mobile health in increasing adherence to exercise (n = 10), increasing adherence to medication (n = 9), increasing adherence to diet (n = 11), increasing care for diabetic foot ulcers (n = 8), increasing self-efficacy and empowerment (n = 5), increasing cholesterol control (n = 4), increasing awareness and attitude (n = 4), increasing control of insulin dose (n = 2), increasing adherence to education (n = 1), and increasing control of blood urea (n = 1), which were considered effective. The use of m-health effectively controls the disease and promotes self-management in type 2 diabetic patients. Considering the high cost of diabetes treatment, policymakers should implement appropriate interventions and strategies in the field of using mobile health to improve adherence to self-management of the disease.

Does fear drive health app adoption? The role of threat perception in diabetes app usage

BACKGROUND AND AIM

This study explores the interplay between fear or threat perception and adoption of health apps among individuals with diabetes. It draws on the concept of "fear" as an emotional response stemming from perceived threat, raising the question of whether threat perception drives the uptake of health apps.

METHODS

This study investigates the influence of diabetes threat perception on app adoption, akin to the role of fear appeal in behavior change communication. This study employed both a handout questionnaire and an online survey tool, Survey Monkey, for data collection. Using purposive sampling, data were collected from 222 individuals aged 35 years and above with diabetes in Chennai.

RESULTS

The results indicate that threat perception can trigger health app usage among people with high diabetic conditions, supporting the broader literature on fear appeal. Additionally, the perceived threat of diabetes is elevated among app users. Notably, a significant positive correlation exists between perceived threat of diabetes, daily app usage, and consistent app use.

CONCLUSION

This study underscores that the extent of perceived harm or vulnerability to threats influences individuals' behavioral changes. It introduces new avenues for encouraging health app usage among high-risk groups.

StepAdd: A personalized mHealth intervention based on social cognitive theory to increase physical activity among type 2 diabetes patients

OBJECTIVE

Investigate the preliminary efficacy and feasibility of a personalized mobile health (mHealth) intervention based on social cognitive theory (SCT) to promote physical activity among type 2 diabetes patients via self-monitoring, goal setting, and automatic feedback.

METHODS

We conducted a pilot study involving 33 type 2 diabetes patients attending Mitsui Memorial Hospital in Japan using a pre-post evaluation design over 12 weeks. Participants measured daily step count, body weight, and blood pressure at home, with the measurements synchronized with the StepAdd application (app) automatically. Participants used the app to review daily results, update personalized step goals, identify individualized barriers to achieving the step goals, find coping strategies to overcome each barrier, and implement these strategies, thereby building effective coping skills to meet the goals. Pharmacists examined the usage of the app and provided coaching on lifestyle modifications. Ultimately, patients established skills to enhance diabetes self-care by using the app.

RESULTS

Daily step count increased dramatically with high statistical significance (p < 0.0001), from a mean of 5436 steps/day to 10,150 steps/day, an 86.7 % increase. HbA1c (p = 0.0001) and BMI (p = 0.0038) also improved. Diabetes self-care in diet, exercise, and foot care as well as self-management behavior, self-regulation, and self-efficacy in achieving daily step goals showed significant improvements. The retention rate of the study was very high, at 97.0 % (n = 32).

CONCLUSIONS

A personalized smartphone-based mHealth intervention based on SCT is feasible and effective at promoting physical activity among type 2 diabetes patients. The methodology of the intervention could be readily applied to other patient populations.

Economic Evaluations of mHealth Interventions for the Management of Type 2 Diabetes: A Scoping Review

BACKGROUND

There is plenty of evidence supporting the clinical benefits of mHealth interventions for type 2 diabetes, but despite often being promoted as cost-effective or cost-saving, there is still limited research to support such claims. The objective of this review was to summarize and critically analyze the current body of economic evaluation (EE) studies for mHealth interventions for type 2 diabetes.

METHODS

Using a comprehensive search strategy, five databases were searched for full and partial EE studies for mHealth interventions for type 2 diabetes from January 2007 to March 2022. "mHealth" was defined as any intervention that used a mobile device with cellular technology to collect and/or provide data or information for the management of type 2 diabetes. The CHEERS 2022 checklist was used to appraise the reporting of the full EEs.

RESULTS

Twelve studies were included in the review; nine full and three partial evaluations. Text messages smartphone applications were the most common mHealth features. The majority of interventions also included a Bluetooth-connected medical device, eg, glucose or blood pressure monitors. All studies reported their intervention to be cost-effective or cost-saving, however, most studies' reporting were of moderate quality with a median CHEERS score of 59%.

CONCLUSION

The current literature indicates that mHealth interventions for type 2 diabetes can be cost-saving or cost-effective, however, the quality of the reporting can be substantially improved. Heterogeneity makes it difficult to compare study outcomes, and the failure to report on key items leaves insufficient information for decision-makers to consider.

Computerization of the Work of General Practitioners: Mixed Methods Survey of Final-Year Medical Students in Ireland

BACKGROUND

The potential for digital health technologies, including machine learning (ML)-enabled tools, to disrupt the medical profession is the subject of ongoing debate within biomedical informatics.

OBJECTIVE

We aimed to describe the opinions of final-year medical students in Ireland regarding the potential of future technology to replace or work alongside general practitioners (GPs) in performing key tasks.

METHODS

Between March 2019 and April 2020, using a convenience sample, we conducted a mixed methods paper-based survey of final-year medical students. The survey was administered at 4 out of 7 medical schools in Ireland across each of the 4 provinces in the country. Quantitative data were analyzed using descriptive statistics and nonparametric tests. We used thematic content analysis to investigate free-text responses.

RESULTS

In total, 43.1% (252/585) of the final-year students at 3 medical schools responded, and data collection at 1 medical school was terminated due to disruptions associated with the COVID-19 pandemic. With regard to forecasting the potential impact of artificial intelligence (AI)/ML on primary care 25 years from now, around half (127/246, 51.6%) of all surveyed students believed the work of GPs will change minimally or not at all. Notably, students who did not intend to enter primary care predicted that AI/ML will have a great impact on the work of GPs.

CONCLUSIONS

We caution that without a firm curricular foundation on advances in AI/ML, students may rely on extreme perspectives involving self-preserving optimism biases that demote the impact of advances in technology on primary care on the one hand and technohype on the other. Ultimately, these biases may lead to negative consequences in health care. Improvements in medical education could help prepare tomorrow's doctors to optimize and lead the ethical and evidence-based implementation of AI/ML-enabled tools in medicine for enhancing the care of tomorrow's patients.

Attitudes and experiences of registered diabetes specialists in using health apps for managing type 2 diabetes: results from a mixed-methods study in Germany 2021/2022

BACKGROUND

Hardly any area of application for health apps is seen to be as promising as health and lifestyle support in type 2 diabetes mellitus. Research has emphasised the benefits of such mHealth apps for disease prevention, monitoring, and management, but there is still a lack of empirical data on the role that health apps play in actual type 2 diabetes care. The aim of the present study was to gain an overview of the attitudes and experiences of physicians specialising in diabetes with regard to the benefits of health apps for type 2 diabetes prevention and management.

METHODS

An online survey was conducted amongst all 1746 physicians at practices specialised in diabetes in Germany between September 2021 and April 2022. A total of 538 (31%) of the physicians contacted participated in the survey. In addition, qualitative interviews were conducted with 16 randomly selected resident diabetes specialists. None of the interviewees took part in the quantitative survey.

RESULTS

Resident diabetes specialists saw a clear benefit in type 2 diabetes-related health apps, primarily citing improvements in empowerment (73%), motivation (75%), and compliance (71%). Respondents rated self-monitoring for risk factors (88%), lifestyle-supporting (86%), and everyday routine features (82%) as especially beneficial. Physicians mainly in urban practice environments were open to apps and their use in patient care despite their potential benefit. Respondents expressed reservations and doubts on app user-friendliness in some patient groups (66%), privacy in existing apps (57%), and the legal conditions of using apps in patient care (80%). Of those surveyed, 39% felt capable of advising patients on diabetes-related apps. Most of the physicians that had already used apps in patient care saw positive effects in increased compliance (74%), earlier detection of or reduction in complications (60%), weight reduction (48%), and decreased HbA1c levels (37%).

CONCLUSIONS

Resident diabetes specialists saw a real-life benefit with added value from health apps for managing type 2 diabetes. Despite the favourable role that health apps may play in disease prevention and management, many physicians expressed reservations regarding usability, transparency, security, and privacy in such apps. These concerns should be addressed more intensively towards bringing about ideal conditions for integrating health apps successfully in diabetes care. This includes uniform standards governing quality, privacy, and legal conditions as binding as possible with regard to apps and their use in a clinical setting.

The Impact of Digital Health Interventions for the Management of Type 2 Diabetes on Health and Social Care Utilisation and Costs: A Systematic Review

BACKGROUND

Digital health interventions such as smartphone applications (mHealth) or Internet resources (eHealth) are increasingly used to improve the management of chronic conditions, such as type 2 diabetes mellitus. These digital health interventions can augment or replace traditional health services and may be paid for using healthcare budgets. While the impact of digital health interventions for the management of type 2 diabetes on health outcomes has been reviewed extensively, less attention has been paid to their economic impact.

OBJECTIVE

This study aims to critically review existing literature on the impact of digital health interventions for the management of type 2 diabetes on health and social care utilisation and costs.

METHODS

Studies that assessed the impact on health and social care utilisation of digital health interventions for type 2 diabetes were included in the study. We restricted the digital health interventions to information provision, self-management and behaviour management. Four databases were searched (MEDLINE, EMBASE, PsycINFO and EconLit) for articles published between January 2010 and March 2021. The studies were analysed using a narrative synthesis approach. The risk of bias and reporting quality were appraised using the ROBINS-I checklist.

RESULTS

The review included 22 studies. Overall, studies reported mixed evidence on the impact of digital health interventions on health and social care utilisation and costs, and suggested this impact differs according to the healthcare utilisation component. For example, digital health intervention use was associated with lower medication use and fewer outpatient appointments, whereas evidence on general practitioner visits and inpatient admissions was mixed. Most reviewed studies focus on a single component of healthcare utilisation.

CONCLUSIONS

The review shows no clear evidence of an impact of digital health interventions on health and social care utilisation or costs. Further work is needed to assess the impact of digital health interventions across a broader range of care utilisation components and settings, including social and mental healthcare services.

CLINICAL TRIAL REGISTRATION

The study protocol was registered on PROSPERO before searches began in April 2021 (registration number: CRD42020172621).

Effects of mobile health interventions on health-related outcomes in older adults with type 2 diabetes: A systematic review and meta-analysis

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition that is associated with multiple comorbidities. Apart from pharmacological approaches, patient self-management remains the gold standard of care for diabetes. Improving patients' self-management among the elderly with mobile health (mHealth) interventions is critical, especially in times of the COVID-19 pandemic. However, the extent of mHealth efficacy in managing T2DM in the older population remains unknown. Hence, the present review examined the effectiveness of mHealth interventions on cardiometabolic outcomes in older adults with T2DM.

METHODS

A systematic search from the inception till May 31, 2021, in the MEDLINE, Embase, and PubMed databases was conducted, and 16 randomized controlled trials were included in the analysis.

RESULTS

The results showed significant benefits on glycosylated hemoglobin (HbA1c) (mean difference -0.24%; 95% confidence interval [CI]: -0.44, -0.05; p = 0.01), postprandial blood glucose (-2.91 mmol/L; 95% CI: -4.78, -1.03; p = 0.002), and triglycerides (-0.09 mmol/L; 95% CI: -0.17, -0.02; p = 0.010), but not on low-density lipoprotein cholesterol (-0.06 mmol/L; 95% CI: -0.14, 0.02; p = 0.170), high-density lipoprotein cholesterol (0.05 mmol/L; 95% CI: -0.03, 0.13; p = 0.220), and blood pressure (systolic blood pressure -0.82 mm Hg; 95% CI: -4.65, 3.00; p = 0.670; diastolic blood pressure -1.71 mmHg; 95% CI: -3.71, 0.29; p = 0.090).

CONCLUSIONS

Among older adults with T2DM, mHealth interventions were associated with improved cardiometabolic outcomes versus usual care. Its efficacy can be improved in the future as the current stage of mHealth development is at its infancy. Addressing barriers such as technological frustrations may help strategize approaches to further increase the uptake and efficacy of mHealth interventions among older adults with T2DM.

How general practitioners and patients discuss type 2 diabetes mellitus and cardiovascular diseases concerns during consultations: Implications for digital health

Objective

To analyse general practitioner-patient consultations about type 2 diabetes mellitus or cardiovascular diseases and describe (i) the nature of self-management discussions; (ii) actions required from patients during and after consultation regarding self-management; and (iii) implications for digital health to support patients during (and after) consultation.

Method

This study screened 281 general practitioner consultations conducted in 2017 within the UK general practice setting from an existing dataset containing videos and transcripts of consultations between GPs and patients. Secondary analysis was conducted using a multi-method approach, including descriptive, content, and visualisation analysis, to inform the nature of self-management discussions, what actions are required from patients, and whether digital technology was mentioned during the consultation to support self-management.

Results

Analysis of eligible 19 consultations revealed a discord between what self-management actions are required of patients during and after consultations. Lifestyle discussions are often discussed in depth, but these discussions rely heavily on subjective inquiry and recall. Some patients in these cohorts are overwhelmed by self-management, to the detriment of their personal health. Digital support for self-management was not a major topic of discussion, however, we identified a number of emergent gaps where digital technology can support self-management concerns.

Conclusion

There is potential for digital technology to reconcile what actions are required of patients during and after consultations. Furthermore, a number of emergent themes around self-management have implications for digitalisation.

Association of multimorbidity with the use of health information technology

Objective

To examine the association of multimorbidity with health information technology use among adults in the USA.

Methods

We used cross-sectional study design and data from the Health Information National Trends Survey 5 Cycle 4. Health information technology use was measured with ten variables comprising access, recent use, and healthcare management. Unadjusted and adjusted logistic and multinomial logistic regressions were used to model the associations of multimorbidity with health information technology use.

Results

Among adults with multimorbidity, health information technology use for specific purposes ranged from 37.8% for helping make medical decisions to 51.7% for communicating with healthcare providers. In multivariable regressions, individuals with multimorbidity were more likely to report general use of health information technology (adjusted odds ratios  =  1.48, 95% confidence intervals  =  1.01-2.15) and more likely to use health information technology to check test results (adjusted odds ratios  =  1.85, 95% confidence intervals  =  1.33-2.58) compared to adults with only one chronic condition, however, there were no significant differences in other forms of health information technology use. We also observed interactive associations of multimorbidity and age on various components of health information technology use. Compared to younger adults with multimorbidity, older adults (≥ 65 years of age) with multimorbidity were less likely to use almost all aspects of health information technology.

Conclusion

Health information technology use disparities by age and multimorbidity were observed. Education and interventions are needed to promote health information technology use among older adults in general and specifically among older adults with multimorbidity.

Design, development, utility and usability testing of the EMPOWER-SUSTAIN Self-Management Mobile App© among primary care physicians and patients with metabolic syndrome

Objective

This study aimed to design, develop, assess and refine the EMPOWER-SUSTAIN Self-Management Mobile App© among primary care physicians (PCP) and patients with metabolic syndrome (MetS) in primary care.

Methodology

Using the software-development-life-cycle (SDLC) iterative model, storyboard and wireframe were drafted; and a mock prototype was designed to illustrate the content and function graphically. Subsequently, a working prototype was developed. Qualitative studies using the 'think-aloud' and cognitive-task-analysis methods were conducted for the utility and usability testing. Topic guide was based on the 10-Nielsen's-Heuristic-Principles. Utility testing was conducted among PCP in which they 'thought-aloud' while performing tasks using the mobile app. Usability testing was conducted among MetS patients after they were given the app for 3 weeks. They 'thought-aloud' while performing tasks using the app. Interviews were audio- and video-recorded, and transcribed verbatim. Thematic content analysis was performed.

Result

Seven PCP and nine patients participated in the utility and usability testing, respectively. Six themes (efficiency of use, user control and freedom, appearance and aesthetic features, clinical content, error prevention, and help and documentation) emerged. PCP found the mobile app attractive and relevant sections were easy to find. They suggested adding 'zoom/swipe' functions and some parts needed bigger fonts. Patients commented that the app was user-friendly, has nice interface, and straightforward language. It helped them understand their health better. Based on these findings, the mobile app was refined.

Conclusion

This app was produced using a robust SDLC method to increase users' satisfaction and sustainability of its use. It could potentially improve self-management behaviour among MetS patients in primary care.

Personal Goals, Barriers to Self-Management and Desired mHealth Application Features to Improve Self-Care in Multi-Ethnic Asian Patients with Type 2 Diabetes: A Qualitative Study

(1) Introduction: The ubiquity of mobile phones suggests the potential of mobile health applications to reach patients with type 2 diabetes and engage them to improve self-care. This study aimed to explore personal goals, barriers to self-management and desired mobile health application features to improve self-care among multi-ethnic Asian patients with type 2 diabetes. (2) Methods: We conducted semi-structured interviews with patients with type 2 diabetes (n = 29). Patients were recruited from a multi-disciplinary center for diabetes and metabolism in Singapore, using a purposive sampling strategy. Various visual materials, collated from existing mobile health application features, were used to facilitate the discussion. Interviews were transcribed verbatim and thematically analyzed. (3) Results: A total of 29 patients participated in 11 focus group discussions or one-on-one interviews. Personal goals for self-management were centered around short-term outcome expectancy, such as better glucose control and a reduced number of medications. Self-management was hampered by competing priorities and limited healthy food options when at work, while a lack of tailored advice from healthcare providers further diminished competence. The desired mobile health app features to improve self-care behaviors included quantifiable goal-setting, personalized nudges based on tracked data, built-in resources from credible sources, in-app social support through virtual interaction with peers and healthcare providers, technology-driven novel data logging and user-defined nudges. (4) Conclusions: We identified a set of app features that may foster motivation to engage in lifestyle modification for patients with T2DM. The findings serve to inform the design of artificial intelligence-enabled mobile health application intervention aimed at improving diabetes self-care.

Pros and cons of telemedicine: implications in cardiology and cardiovascular medicine

The COVID-19 pandemic has highlighted the vitalness of telehealth in our medical world, where considering a restructuring of healthcare services has become paramount. Indeed, in the context of this still ongoing pandemic, medical institutions must strive to improve telehealth technologies and implement solid future research directions in this growing field - to be able to persevere in meeting the needs of the patients. As long as no conclusive evidence exists regarding the fields where telemedicine is most worthwhile, healthcare systems will always keep the dread of wasting resources on developing ineffective programs. We gathered that telemedicine has been attributed a considerable attention in managing cardiac/cardiovascular conditions; nevertheless, further studies with solid designs are still needed to confirm its validity/utility within these specialties.

The effectiveness of digital health technologies for patients with diabetes mellitus: A systematic review

Introduction

Diabetes mellitus (DM) is a leading cause of morbidity and mortality worldwide. At the same time, digital health technologies (DHTs), which include mobile health apps (mHealth) have been rapidly gaining popularity in the self-management of chronic diseases, particularly following the COVID-19 pandemic. However, while a great variety of DM-specific mHealth apps exist on the market, the evidence supporting their clinical effectiveness is still limited.

Methods

A systematic review was performed. A systematic search was conducted in a major electronic database to identify randomized controlled trials (RCTs) of mHealth interventions in DM published between June 2010 and June 2020. The studies were categorized by the type of DM and impact of DM-specific mHealth apps on the management of glycated haemoglobin (HbA1c) was analysed.

Results

In total, 25 studies comprising 3,360 patients were included. The methodological quality of included trials was mixed. Overall, participants diagnosed with T1DM, T2DM and Prediabetes all demonstrated greater improvements in HbA1c as a result of using a DHT compared with those who experienced usual care. The analysis revealed an overall improvement in HbA1c compared with usual care, with a mean difference of –0.56% for T1DM, –0.90% for T2DM and –0.26% for Prediabetes.

Conclusion

DM-specific mHealth apps may reduce HbA1c levels in patients with T1DM, T2DM and Prediabetes. The review highlights a need for further research on the wider clinical effectiveness of diabetes-specific mHealth specifically within T1DM and Prediabetes. These should include measures which go beyond HbA1c, capturing outcomes including short-term glycemic variability or hypoglycemic events.

Graphene: A Path-Breaking Discovery for Energy Storage and Sustainability

The global energy situation requires the efficient use of resources and the development of new materials and processes for meeting current energy demand. Traditional materials have been explored to large extent for use in energy saving and storage devices. Graphene, being a path-breaking discovery of the present era, has become one of the most-researched materials due to its fascinating properties, such as high tensile strength, half-integer quantum Hall effect and excellent electrical/thermal conductivity. This paper presents an in-depth review on the exploration of deploying diverse derivatives and morphologies of graphene in various energy-saving and environmentally friendly applications. Use of graphene in lubricants has resulted in improvements to anti-wear characteristics and reduced frictional losses. This comprehensive survey facilitates the researchers in selecting the appropriate graphene derivative(s) and their compatibility with various materials to fabricate high-performance composites for usage in solar cells, fuel cells, supercapacitor applications, rechargeable batteries and automotive sectors.

Bedeutung und Einsatzpotenziale von Gesundheits-Apps in der diabetologischen Versorgung – Ergebnisse einer Befragungsstudie

Hintergrund Mit Blick auf Diabetes mellitus Typ 2 als lebensstilinduzierte Erkrankung wird ein großer potenzieller Nutzen in Gesundheits-Apps gesehen, die gesundheitsunterstützend bei Prävention und Monitoring oder auch der Therapie helfen sollen. Das Ziel der Studie ist es, den Anwendungshorizont, die Akzeptanz und Einstellungen sowie Erfahrungen von Ärzt*innen aus diabetologischen Schwerpunktpraxen hinsichtlich des Nutzungspotenzials von Gesundheits-Apps für Diagnostik, Therapie und Prävention bei Diabetes mellitus Typ 2 explorativ zu beleuchten.

Methodik Aufbauend auf mehreren Vorstudien wurden mittels schriftlicher Befragung zwischen März und Mai 2021 insgesamt 291 Ärzt*innen diabetologischer Schwerpunktpraxen in Rheinland-Pfalz, Hessen, Thüringen und dem Saarland anonymisiert befragt. Die Rücklaufquote beträgt 30% (N=88). Neben der deskriptiven Analyse wurde ein t-Test bei unabhängigen Stichproben durchgeführt.

Ergebnisse Die Befragten verbinden mit dem Einsatz von Apps eine wirksame Stärkung von Empowerment, Motivation und Compliance, aber auch durch Erinnerungs- und lebensstilunterstützenden Funktionen eine mögliche Effektivierung der Prävention und des Erkrankungsmanagements von Typ-2-Diabetes-Patient*innen. Gerade jüngere Ärzt*innen in städtischen Praxisumgebungen begegnen Gesundheits-Apps mit positiver Einstellung und greifen im Praxisalltag auf solche Tools zurück. Skepsis besteht auf Seiten der Befragten u.a. in Bezug auf die Anwendungsfreundlichkeit und Datensicherheit bestehender Apps sowie hinsichtlich rechtlicher Fragestellungen. Eine Mehrheit räumt ein, keinen ausreichenden Überblick über diabetologische Apps zu besitzen und traut sich eine Beratung von Patient*innen nur bedingt zu. Diejenigen Ärzt*innen, bei denen Apps schon in der Versorgung Einzug fanden, beobachten in großer Mehrzahl positive Effekte bei der Steigerung der Compliance, im schnelleren Aufdecken bzw. Verringern von Komplikationen, bei der Gewichtsreduktion sowie bei der Abnahme des HbA1c-Werts.

Diskussion Trotz der positiver Effekte, die Gesundheits-Apps für Prävention und Therapie haben können, bestehen bei vielen diabetologischen Ärzt*innen Vorbehalte hinsichtlich der Überschaubarkeit, Transparenz und Sicherheit von Apps. Diese Bedenken sollten verstärkt adressiert werden, um die richtigen Voraussetzungen für eine erfolgreiche Integration von Gesundheits-Apps in die diabetologische Versorgung zu schaffen (u.a. verbindliche Datenschutz- und Qualitätsstandards, klare Rechtslage in Bezug auf die Anwendung von Apps, Schulungen, Tools zur Übersicht und Einordnung).

Effectiveness of a mobile-based educational intervention on self-care activities and glycemic control among the elderly with type 2 diabetes in southwest of Iran in 2020

Background

The elderly constitute a large fraction of patients with type 2 diabetes worldwide. It has been well documented that the elderly’s adherence to disease control is not adequate. The present study aimed to evaluate the impact of a mobile-based educational intervention on self-care behaviors and glycemic control among elderly with type 2 diabetes.

Methods

The present study was conducted on 118 older people (59 in the intervention group and 59 in the control group) with type 2 diabetes who referred to Golestan Hospital in Ahvaz, southwest of Iran in 2020. Participants were randomly divided into experimental and control groups. Data were collected at baseline and after a 3-month follow-up. At baseline, the participants completed a valid and reliable multi-section questionnaire including items on attitude, the multidimensional scale of perceived social support (MSPSS), the Coping Self-Efficacy Scale (CSES), self-care constructs, and HBA1C. After analyzing the pre-test data, we designed a training program which was offered to the intervention group online via mobile phone in three online sessions. The control group, however, received no intervention except diabetes routine care. Data were analyzed using SPSS-15 at a significance level of 0.05.

Results

Before the intervention, the mean scores of CSES, attitudes towards self-care, MSPSS, and self-care were not statistically significant between study groups (P > 0.05), but after intervention, the study found significant differences between the groups in terms of CSES, attitude, MSPSS, and self-care (P = 0.001). Furthermore, after implementation of the intervention, the mean value of HbA1C in the intervention group was significantly less than that of the control group (7.00 vs. 7.32%) (P = 0.001).

Conclusion

The present results indicated that implementing an educational intervention via mobile phone can improve self-care practice and reduce HbA1C in the elderly with type 2 diabetes. The study also showed a moderate to large effect on the outcome variables. However, further studies with longer follow-up periods are recommended to confirm the results.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00957-5.

- The study provided a framework for developing a targeted mobile phone health education intervention.

- Mobile phone education can improve both behavioral and clinical indexes. This intervention increased the scores of perceived social support (MSPSS) and Coping Self-Efficacy Scale (CSES), and self-care practice and reduced HbA1C in the elderly with type 2 diabetes.

- Further studies with longer follow-up periods are warranted.

Promoting Physical Activity in Older Adults With Type 2 Diabetes via an Anthropomorphic Conversational Agent: Development of an Evidence and Theory-Based Multi-Behavior Intervention

Introduction

Anthropomorphic conversational agents (ACA) are a promising digital tool to support self-management of type 2 diabetes (T2D), albeit little explored. There is a dearth of literature on the detailed content of these interventions, which may limit effectiveness and replication. Our aim is to describe the development of an evidence and theory-based intervention to improve physical activity in older adults with T2D, subsumed in a multi-behavior intervention via a mobile application with an ACA.

Methods

Overall decisions on the multi-behavior intervention design, such as the use of standardized behavior change techniques (BCTTv1), guided the development of the physical activity component. Firstly, recommendations on ambulatory activity were used to select the target behavior (walking). Meta-research on effective behavior change techniques (BCTs) was then identified. One meta-analysis linked effective BCTs with the three basic psychological needs of the self-determination theory (SDT). This meta-analysis, taken together with additional evidence on SDT, led to the selection of this theory to inform the design. BCTs were extracted from meta-research; we selected the most appropriate to be operationalized via the conversational agent through multidisciplinary discussions. Rules governing the dialogue flow and BCTs tailoring, taking the form "if some conditions hold then execute some action," were derived based on the Basic Psychological in Exercise Scale (competence, autonomy, and relatedness scores), in conjunction with published evidence and multidisciplinary discussions.

Results

Thirteen BCTs were implemented in the prototype via the ACA (e.g., goal setting behavior 1.1). Six if-then rules were derived and depicted in the dialogue steps through process flow diagrams, which map how the system functions. An example of a rule is "If competence score ≤ 10 then, apply BCT 1.1 with 500 steps increments as options for the daily walking goal; If competence score > 10 then, apply BCT 1.1 with 1,000 steps increments as options for the daily walking goal."

Conclusion

Evidence and SDT were translated into a mobile application prototype using an ACA to promote physical activity in older adults with T2D. This approach, which includes 13 BCTs and six if-then rules for their tailoring, may leverage the efforts of others in developing similar interventions.

Efficacy of the mHealth application in patients with type 2 diabetes transitioning from inpatient to outpatient care: A randomized controlled clinical trial

INTRODUCTION

No studies have assessed the efficacy of telemedicine using a platform for recording and adjusting insulin doses in patients with diabetes mellitus type 2 (DM2) transitioning from inpatient to outpatient care. This study aimed to assess, in a population of patients with DM2, discharged from a tertiary referral hospital, whether treatment based on the use of an mHealth application was associated with better glycemic control at the 3-month follow-up, than standard care.

METHODS

This open, randomized, controlled clinical trial included adult DM2 patients who were transitioning from inpatient to outpatient care. The efficacy and safety of patient management with and without mHealth was compared at the 3-month follow-up. The primary outcome was the change in the Glycosylated hemoglobin (HbA1c) levels. The secondary outcomes were the rates of hypoglycemic and hyperglycemic events and treatment satisfaction measured using the Insulin Treatment Satisfaction Questionnaire (ITSQ).

RESULTS

In total, 86 patients (41 using mHealth) were included in the clinical trial. HbA1c levels showed a significant decrease in both groups. The mean HbA1c level was significantly lower in the mHealth group. Patients using mHealth showed decreased incidence rate ratios of hypoglycemia 3.0 mmol/L [<54 mg/dl], hypoglycemia ranging from 3.0 to 3.8 mmol/L [54 to 70 mg/dl] and severe hypoglycemia. The level of satisfaction assessed using the ITSQ was higher in the mHealth group.

CONCLUSION

Using mHealth in patients with DM2 transitioning from inpatient to outpatient care improves metabolic control and may reduce the hypoglycemia rates.

Qatar Diabetes Mobile Application Trial (QDMAT): an open-label randomised controlled trial to examine the impact of using a mobile application to improve diabetes care in type 2 diabetes mellitus-a study protocol

Background

Mobile health (mHealth) is increasingly advocated for diabetes management. It is unclear if mobile applications are effective in improving glycaemic control, clinical outcomes, quality of life and overall patient satisfaction in patients with type 2 diabetes (T2DM). A new mobile application was specifically built for people with T2DM with the help of the local expertise. The objective of the study was to evaluate the effectiveness of the mobile app.

Methods

The planned study is an ongoing open-label randomised controlled trial in which adults living with T2DM treated with insulin will be randomised 1:1 to the use of this diabetes application versus current standard care. The primary outcome will be the difference in mean HbA1c from baseline to 6 months. Other outcome measures include anthropometric measures, hypoglycaemic events, medication adjustments, number of clinical interactions and missed appointments and patient perceptions of their disease and diabetes self-management. The study will randomise 180 subjects for assessment of the primary outcome.

Discussion

We hypothesise that the diabetes-specific mobile application will improve glycaemic control, increase patient empowerment for self-management of diabetes and improve interaction between patients and healthcare providers. If the Qatar Diabetes Mobile Application Trial (QDMAT) demonstrates this, it will inform clinical services for the future self-management of T2DM.

Trial registration

ClinicalTrials.gov Identifier: NCT03998267. Registered on 26 June 2019

Development and implementation of an interprofessional digital platform to increase therapeutic adherence: a mixed design (Preprint)

Background

Adherence to care plans is a major issue in health care systems. Improved adherence has several potential benefits such as ensuring treatment effectiveness and control of chronic diseases. There is currently a lack of tools to maximize treatment adherence in an integrated manner, that is, covering multiple aspects of patients’ health continuously throughout their medical care. To ensure better adherence, such tools must meet the needs of patients with chronic conditions as well as those of health care professionals. Acknowledging the health issues associated with nonadherence to treatment, an industry-research-clinical partnership aims to adapt a digital platform—facilitating patient-health care professional interactions—to improve therapeutic adherence in patients with chronic illnesses. The platform allows for exchanges between patients and health care professionals to facilitate the timing of medication use or chronic disease management and maximize patient adherence.

Objective

This study aims to (1) identify the needs of patients living with a chronic condition and their health professionals concerning their interactions regarding treatment; (2) codevelop an adaptation of an interactive patient-professional platform that meets the needs identified; and (3) then test the platform and document its effects and acceptability in a clinical setting.

Methods

The study will use a creative design thinking process based on the needs expressed by users (patients and health professionals) concerning treatment adherence for chronic diseases (eg, diabetes, asthma, high blood pressure, depression and anxiety, chronic obstructive pulmonary disease). A mixed method evaluation research design will be used to develop and evaluate the platform. Qualitative data will be used to assess user needs and acceptability of the platform, and quantitative data will provide the necessary insights to document its effects.

Results

Technological development of the platform has been completed. Recruitment for the first part of Phase 1 started in May 2022. The results of this project to codevelop an interprofessional digital platform to increase therapeutic adherence will be relevant to clinicians and managers seeking contemporary solutions that support patient adherence to treatment for chronic diseases. These results will enable optimal use of the platform and identify areas for improvement in interactive patient-health care professional apps.

Conclusions

The adoption of an interactive digital platform to facilitate effective exchanges between patients and health care professionals in primary care settings could improve adherence to treatment. The platform tested in this project takes a first step in this direction by ensuring that the technological product is developed according to the needs of patients as well as the health professionals who are likely to use it.

International Registered Report Identifier (IRRID)

DERR1-10.2196/34463

Effects of a Novel Blood Glucose Forecasting Feature on Glycemic Management and Logging in Adults With Type 2 Diabetes Using One Drop: Retrospective Cohort Study

Background

Personalized feedback is an effective behavior change technique frequently incorporated into mobile health (mHealth) apps. Innovations in data science create opportunities for leveraging the wealth of user data accumulated by mHealth apps to generate personalized health forecasts. One Drop’s digital program is one of the first to implement blood glucose forecasts for people with type 2 diabetes. The impact of these forecasts on behavior and glycemic management has not been evaluated to date.

Objective

This study sought to evaluate the impact of exposure to blood glucose forecasts on blood glucose logging behavior, average blood glucose, and percentage of glucose points in range.

Methods

This retrospective cohort study examined people with type 2 diabetes who first began using One Drop to record their blood glucose between 2019 and 2021. Cohorts included those who received blood glucose forecasts and those who did not receive forecasts. The cohorts were compared to evaluate the effect of exposure to blood glucose forecasts on logging activity, average glucose, and percentage of glucose readings in range, after controlling for potential confounding factors. Data were analyzed using analysis of covariance (ANCOVA) and regression analyses.

Results

Data from a total of 1411 One Drop users with type 2 diabetes and elevated baseline glucose were analyzed. Participants (60.6% male, 795/1311; mean age 50.2 years, SD 11.8) had diabetes for 7.1 years on average (SD 7.9). After controlling for potential confounding factors, blood glucose forecasts were associated with more frequent blood glucose logging (P=.004), lower average blood glucose (P<.001), and a higher percentage of readings in range (P=.03) after 12 weeks. Blood glucose logging partially mediated the relationship between exposure to forecasts and average glucose.

Conclusions

Individuals who received blood glucose forecasts had significantly lower average glucose, with a greater amount of glucose measurements in a healthy range after 12 weeks compared to those who did not receive forecasts. Glucose logging was identified as a partial mediator of the relationship between forecast exposure and week-12 average glucose, highlighting a potential mechanism through which glucose forecasts exert their effect. When administered as a part of a comprehensive mHealth program, blood glucose forecasts may significantly improve glycemic management among people living with type 2 diabetes.

Development and Effectiveness of a Mobile Health Intervention in Improving Health Literacy and Self-management of Patients With Multimorbidity and Heart Failure: Protocol for a Randomized Controlled Trial

Background

Patients with multimorbidity and complex health needs are defined as a priority by the World Health Organization (WHO) and the European Union. There is a need to develop appropriate strategies with effective measures to meet the challenge of chronicity, reorienting national health systems. The increasing expansion of mobile health (mHealth) interventions in patient communication, the reduction of health inequalities, improved access to health care resources, adherence to treatment, and self-care of chronic diseases all point to an optimistic outlook. However, only few mobile apps demonstrate their effectiveness in these patients, which is diminished when they are not based on evidence, or when they are not designed by and for users with different levels of health literacy (HL).

Objective

This study aims to evaluate the efficacy of an mHealth intervention relative to routine clinical practice in improving HL and self-management in patients with multimorbidity with heart failure (HF) and complex health needs.

Methods

This is a randomized, multicenter, blinded clinical trial evaluating 2 groups, namely, a control group (standard clinical practice) and an intervention group (standard clinical practice and an ad hoc designed mHealth intervention previously developed), for 12 months.

Results

The contents of the mHealth intervention will address user-perceived needs based on the development of user stories regarding diet, physical exercise, cardiac rehabilitation, therapeutic adherence, warning signs and symptoms, and emotional management. These contents have been validated by expert consensus. The creation and development of the contents of the mHealth intervention (app) took 18 months and was completed during 2021. The mobile app is expected to be developed by the end of 2022, after which it will be applied to the experimental group as an adjunct to standard clinical care during 12 months.

Conclusions

The trial will demonstrate whether the mobile app improves HL and self-management in patients with HF and complex health needs, improves therapeutic adherence, and reduces hospital admissions. This study can serve as a starting point for developing other mHealth tools in other pathologies and for their generalization to other contexts.

Trial Registration

ClinicalTrials.gov NCT04725526; https://tinyurl.com/bd8va27w

International Registered Report Identifier (IRRID)

DERR1-10.2196/35945

Standardized evaluation of the quality and persuasiveness of mobile health applications for diabetes management

This study evaluates diabetes self-management mobile health applications available from European app stores with respect to quality, concordance with recommended self-management tasks and implementation of persuasive system design principles. The European Play Store and Apple App Store were systematically searched and relevant apps were tested. Two raters independently assessed app quality using the Mobile Application Rating Scale and conducted a content analysis of provided persuasive system design principles and self-management tasks. A total of 2,269 mobile health applications were identified and 120 could be included in the evaluation. The overall quality was rated as moderate M = 3.20 (SD = 0.39, min = 2.31, max = 4.62), with shortcomings in the subcategories of engagement (M = 2.80, SD = 0.67) and information quality (M = 2.26, SD = 0.48). Scientific evidence is available for 8% of the apps. The reviewed apps implemented a median of three persuasive system design principles (range 0-15) and targeted a median of 4.5 (range 1-8) self-management tasks, however, with a lack of information about psychosocial coping strategies. Most available diabetes self-management apps lack a scientific evidence base. Persuasive system design features are underrepresented and may form a promising tool to improve app quality. Furthermore, the interaction of physical and behavioral health should be improved in existing diabetes self-management mobile health applications.

Epidemiological Algorithm for Early Detection of COVID-19 Cases in a Mexican Oncologic Center

An early detection tool for latent COVID-19 infections in oncology staff and patients is essential to prevent outbreaks in a cancer center. (1) Background: In this study, we developed and implemented two early detection tools for the radiotherapy area to identify COVID-19 cases opportunely. (2) Methods: Staff and patients answered a questionnaire (electronic and paper surveys, respectively) with clinical and epidemiological information. The data were collected through two online survey tools: Real-Time Tracking (R-Track) and Summary of Factors (S-Facts). Cut-off values were established according to the algorithm models. SARS-CoV-2 qRT-PCR tests confirmed the positive algorithms individuals. (3) Results: Oncology staff members (n = 142) were tested, and 14% (n = 20) were positives for the R-Track algorithm; 75% (n = 15) were qRT-PCR positive. The S-Facts Algorithm identified 7.75% (n = 11) positive oncology staff members, and 81.82% (n = 9) were qRT-PCR positive. Oncology patients (n = 369) were evaluated, and 1.36% (n = 5) were positive for the Algorithm used. The five patients (100%) were confirmed by qRT-PCR. (4) Conclusions: The proposed early detection tools have proved to be a low-cost and efficient tool in a country where qRT-PCR tests and vaccines are insufficient for the population.

A qualitative evidence synthesis of users' experience of mobile health applications in the self-management of type 2 diabetes

AIM

The aim of this qualitative evidence synthesis was to identify and synthesise qualitative research relating to experiences of using mobile health (mHealth) applications to aid self-management of Type 2 Diabetes.

METHODS

Using a systematic search strategy, 11 databases were searched (Medline, CINAHL, PsychInfo, PubMed, Web of Science, Embase, Cochrane Library, Scopus, ProQuest A&1, ProQuest UK & Ireland, Mednar). "Best fit" framework synthesis was used guided by the Health Information Technology Acceptance Model (HITAM). Assessment of methodological limitations was conducted using Critical Appraisal Skills Programme (CASP) and confidence in the review findings were guided by GRADE-CERQual.

RESULTS

Fourteen eligible studies were included in the synthesis (7 qualitative and 5 mixed methods). Key themes identified under the health, information and technology zones of the HITAM revealed the benefits of mHealth apps, barriers to their use, their perceived usefulness and ease of use.

DISCUSSION

Most people used the apps for feedback on their self-management and found them helpful in their communication with health care providers. Some embraced the technology and found it easy to use while others found mHealth apps to be counterintuitive.

Comparative Efficacy of Strategies to Support Self-Management in Patients with Asthma: A Systematic Review and Network Meta-Analysis

BACKGROUND

There is limited evidence about which composite feature of asthma self-management strategies is the best and should be adopted into practice.

OBJECTIVE

To compare the efficacy of different strategies to support self-management, based on the newly developed framework, in patients with asthma.

METHODS

We searched PubMed, EMBASE, CENTRAL, CINAHL, and PsycInfo from 1993 to December 2019. We identified randomized controlled trials that explored effects of strategies to support self-management in adult patients with asthma. We conducted network meta-analyses using a random effects model with usual care as the common comparator. Surface under the cumulative ranking curve methods were used to rank different support strategies.

RESULTS

Thirty-five trials (5195 patients) were included and classified on the basis of our newly created TIP framework: Theme, Intensity, and Provider/Platform. We identified 6 features from the included trials, each represented by 1 element of the TIP framework: (1) behavioral support more than once a month by e-Health; (2) behavioral support more than once a month by health care personnel (HCP); (3) behavioral support less often than or equal to once a month by HCP; (4) education support less often than or equal to once a month by e-Health; (5) education support less often than or equal to once a month by HCP; and (6) psychosocial support less often than or equal to once a month by HCP. Behavioral support more than once a month by e-Health showed significant improvement in asthma control when compared with the other 2 support strategies, which was confirmed by the highest surface under the cumulative ranking of 97.6%. However, the surface under the cumulative ranking for behavioral support less often than or equal to once a month by HCP suggested that it has the potential to be the best intervention to reduce the risk of hospitalization (89.1%) and emergency department visit (84.2%).

CONCLUSIONS

Different features of asthma self-management support strategies work best on unique outcomes.

Video-based smartphone app ('VIDEA bewegt') for physical activity support in German adults: a single-armed observational study

OBJECTIVES

The primary objective of this study was to investigate the effect of the video-based smartphone app 'VIDEA bewegt' over eight programme weeks on physical activity in German adults.

DESIGN

The study used a single-arm observational design, assessing the app's effectiveness under real-life conditions. Data were collected from July 2019 to July 2020.

SETTING

The app is enabling users to access video-based educational content via their smartphone. A clinical visit or in-person contact was not required.

PARTICIPANTS

All individuals registered in the freely available app were invited to take part in the study.

INTERVENTIONS

The app aims to increase physical activity in everyday life. It combines educative videos on lifestyle-related benefits and instructional videos of strength and endurance exercises to do at home with motivational components like goal setting, documentation of progress and personalised messages.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcomes were physical activity based one MET minutes per week (metabolic equivalent) and step numbers.Secondary outcomes included physical self-efficacy (motivational, maintenance, recovery self-efficacy), health-related quality of life: Mental Health Component Summary score and Physical Health Component Summary score.

RESULTS

Of 97 people included in the data analysis, 55 successfully completed the programme and all questionnaires. Significant increases over eight programme weeks (between T0 and T2) were observed in physical activity based on MET minutes per week, health-related quality of life, and recovery self-efficacy. Time spent sitting and body mass index significantly decreased for those completing the programme.

CONCLUSIONS

Although significant benefits of physical activity were observed following a complete-case analysis, results should be dealt with caution. Studies with a larger and less heterogeneous sample and robust study designs able to measure causal effects would be desirable.

TRIAL REGISTRATION NUMBER

DRKS00017392.

Use of Mobile Apps for Self-care in People With Parkinson Disease: Systematic Review

BACKGROUND

Self-care is essential for people with Parkinson disease (PD) to minimize their disability and adapt to alterations in physical abilities due to this progressive neurodegenerative disorder. With rapid developments in mobile technology, many health-related mobile apps for PD have been developed and used. However, research on mobile app-based self-care in PD is insufficient.

OBJECTIVE

This study aimed to explore the features and characteristics of mobile apps for self-care in people with PD.

METHODS

This study was performed sequentially according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Web of Science, and PsycINFO were searched in consultation with a librarian on June 8, 2021. We used keywords including "Parkinson disease" and "mobile."

RESULTS

A total of 17 studies were selected based on the inclusion criteria, including 3 randomized controlled trials and 14 observational studies or quasi-experimental studies. The use of mobile apps for self-care in people with PD focused on symptom monitoring, especially motor symptoms. Motor symptoms were objectively measured mainly through the sensors of smartphones or wearable devices and task performance. Nonmotor symptoms were monitored through task performance or self-reported questionnaires in mobile apps. Most existing studies have focused on clinical symptom assessment in people with PD, and there is a lack of studies focusing on symptom management.

CONCLUSIONS

Mobile apps for people with PD have been developed and used, but strategies for self-management are insufficient. We recommend the development of mobile apps focused on self-care that can enhance symptom management and health promotion practices. Studies should also evaluate the effects of mobile apps on symptom improvement and quality of life in people with PD.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42021267374; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021267374.

Encouraging Behavior Changes and Preventing Cardiovascular Diseases Using the Prevent Connect Mobile Health App: Conception and Evaluation of App Quality

Background

Cardiovascular diseases are a major cause of death worldwide. Mobile health apps could help in preventing cardiovascular diseases by improving modifiable risk factors such as eating habits, physical activity levels, and alcohol or tobacco consumption.

Objective

The aim of this study was to design a mobile health app, Prevent Connect, and to assess its quality for (1) assessing patient behavior for 4 cardiovascular risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and (2) suggesting personalized recommendations and mobile health interventions for risky behaviors.

Methods

The knowledge base of the app is based on French national recommendations for healthy eating, physical activity, and limiting alcohol and tobacco consumption. It contains a list of patient behaviors and related personalized recommendations and digital health interventions. The interface was designed according to usability principles. Its quality was assessed by a panel of 52 users in a 5-step process: completion of the demographic form, visualization of a short presentation of the app, testing of the app, completion of the user version of the Mobile App Rating Scale (uMARS), and an open group discussion.

Results

This app assesses patient behaviors through specific questionnaires about 4 risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and suggests personalized recommendations and digital health interventions for improving behavior. The app was deemed to be of good quality, with a mean uMARS quality score of 4 on a 5-point Likert scale. The functionality and information content of the app were particularly appreciated, with a mean uMARS score above 4. Almost all the study participants appreciated the navigation system and found the app easy to use. More than three-quarters of the study participants found the app content relevant, concise, and comprehensive. The aesthetics and the engagement of the app were also appreciated (uMARS score, 3.7). Overall, 80% (42/52) of the study participants declared that the app helped them to become aware of the importance of addressing health behavior, and 65% (34/52) said that the app helped motivate them to change lifestyle habits.

Conclusions

The app assessed the risky behaviors of the patients and delivered personalized recommendations and digital health interventions for multiple risk factors. The quality of the app was considered to be good, but the impact of the app on behavior changes is yet to be demonstrated and will be assessed in further studies.

Usefulness of wearable fitness tracking devices in patients undergoing esophagectomy

BACKGROUND

Esophageal cancer surgery requires maintenance and enhancement of perioperative nutritional status and physical function to prevent postoperative complications. Therefore, awareness of the importance of preoperative patient support is increasing. This study examined the usefulness of using a diary in combination with a wearable fitness tracking device (WFT) in patients undergoing surgery for esophageal cancer.

METHODS

Ninety-four patients who underwent esophagectomy between February 2019 and April 2021 were included. Physicians, nurses, dietitians, and physical therapists provided diary-based education for the patients. In addition, a WFT was used by some patients. The perioperative outcomes of patients who used both the diary and WFT (WFT group) and those who used the diary alone (non-WFT group) were compared. In addition, propensity score matching was performed to improve comparability between the two groups.

RESULTS

After the propensity score matching, the rate of postoperative pneumonia was significantly lower in the WFT group (0% vs. 22.6%, P = 0.005). The postoperative hospital stay was shorter in the WFT group (P = 0.012). Nutritional status indices, such as the prognostic nutritional index, also improved significantly in the WFT group at 1 month after surgery (P = 0.034). The rate of diary entries was significantly higher in the WFT group (72.3% vs. 28.3%, P < 0.001).

CONCLUSION

The use of a WFT reduced the incidence of postoperative pneumonia and improved postoperative nutritional status and rates of diary entries after esophagectomy, suggesting that its use may be useful for promoting recovery after esophagectomy.

Effectivness of specific mobile health applications (mHealth-apps) in gestational diabtetes mellitus: a systematic review

BACKGROUND

Gestational diabetes mellitus (GDM) emerges worldwide and is closely associated with short- and long-term health issues in women and their offspring, such as pregnancy and birth complications respectively comorbidities, Type 2 Diabetes (T2D), metabolic syndrome as well as cardiovascular diseases. Against this background, mobile health applications (mHealth-Apps) do open up new possibilities to improve the management of GDM. Therefore, we analyzed the clinical effectiveness of specific mHealth-Apps on clinical health-related short and long-term outcomes in mother and child.

METHODS

A systematic literature search in Medline (PubMed), Cochrane Library, Embase, CINAHL and Web of Science Core Collection databases as well as Google Scholar was performed. We selected studies published 2008 to 2020 analyzing women diagnosed with GDM using specific mHealth-Apps. Controlled clinical trials (CCT) and randomized controlled trials (RCT) were included. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool.

RESULTS

In total, n = 6 publications (n = 5 RCTs, n = 1 CCT; and n = 4 moderate, n = 2 weak quality), analyzing n = 408 GDM patients in the intervention and n = 405 in the control groups, were included. Compared to control groups, fasting blood glucose, 2-h postprandial blood glucose, off target blood glucose measurements, delivery mode (more vaginal deliveries and fewer (emergency) caesarean sections) and patient compliance showed improving trends.

CONCLUSION

mHealth-Apps might improve health-related outcomes, particularly glycemic control, in the management of GDM. Further studies need to be done in more detail.

Validation of a Virtual Assistant for Improving Medication Adherence in Patients with Comorbid Type 2 Diabetes Mellitus and Depressive Disorder

Virtual assistants are programs that interact with users through text or voice messages simulating a human-based conversation. The development of healthcare virtual assistants that use messaging platforms is rapidly increasing. Still, there is a lack of validation of these assistants. In particular, this work aimed to validate the effectiveness of a healthcare virtual assistant, integrated within messaging platforms, with the aim of improving medication adherence in patients with comorbid type 2 diabetes mellitus and depressive disorder. For this purpose, a nine-month pilot study was designed and subsequently conducted. The virtual assistant reminds patients about their medication and provides healthcare professionals with the ability to monitor their patients. We analyzed the medication possession ratio (MPR), measured the level of glycosylated hemoglobin (HbA1c), and obtained the patient health questionnaire (PHQ-9) score in the patients before and after the study. We also conducted interviews with all participants. A total of thirteen patients and five nurses used and evaluated the proposed virtual assistant using the messaging platform Signal. Results showed that on average, the medication adherence improved. In the final interview, 69% of the patients agreed with the idea of continuing to use the virtual assistant after the study.

Telemedicine via Continuous Remote Care: A Proactive, Patient-Centered Approach to Improve Clinical Outcomes

The COVID-19 pandemic has revolutionized health care for patients and providers alike. Telemedicine has moved from the periphery of our health care system to center stage more rapidly than anyone could have envisioned. Currently, virtual care has quite effectively replicated the traditional health system’s care delivery model and reimbursement structure—a patient makes an appointment, then sees a physician (except with video or phone replacing in-office visits) who makes a care plan, and the patient and physician meet again at a later timepoint to assess progress. Replicating this episodic care paradigm virtually has been invaluable for delivering care swiftly during the COVID-19 pandemic; however, we can and should do more with the connectedness and convenience that telemedicine technology enables. Continuous remote care, with a data-driven, proactive outreach to patients, represents a decisive step forward in contrast to the currently available episodic, reactive, patient-initiated care. In the context of continuous remote care, patient biometric and symptom data (patient entered and connected data) are assimilated in real time by artificial intelligence–enabled clinical platforms to bring physicians' and other health care team members’ attention to those patients who need intervention, whether this is via medication adjustments, acute care management, or lifestyle coaching. In this paper, we discuss how an innovative continuous remote care approach has improved outcomes in another deadly pandemic—type 2 diabetes mellitus.

Narrative review on clinical considerations for patients with diabetes and COVID-19: More questions than answers

BACKGROUND-AIM

Diabetes, obesity and hypertension are common comorbidities associated with increased severity and mortality rates from Corona Virus Disease (COVID)-19.

METHODS

In this narrative review (using the PubMed database), we discuss epidemiological data and pathophysiological links between diabetes and COVID-19. The potential effects of glycaemic control and antidiabetic drugs on the prevalence and outcomes of COVID-19 are also reviewed, as well as the role of telemedicine and diabetes self-management in the post-COVID-19 era.

RESULTS

Diabetes has been linked to COVID-19 morbidity and mortality, although further research is needed to elucidate this association. In the meantime, physicians should be aware of the potential rise in the prevalence of diabetes (due to unhealthy lifestyle changes during the pandemic), its severity and complications and focus on achieving optimal diabetes prevention and management. Telemedicine and diabetes self-management may help towards this direction. Dipeptidyl-peptidase 4 (DPP4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose transporter 2 (SGLT2) inhibitors may affect viral entry and infection, and thus COVID-19 outcomes, as shown in observational studies.

CONCLUSION

Diabetes has been associated with COVID-19 development and progression. Certain antidiabetic drugs may influence COVID-19 prevention and management. The results of ongoing randomized clinical trials will shed more light on this field.

Development features and study characteristics of mobile health apps in the management of chronic conditions: a systematic review of randomised trials

COVID-19 pandemic challenges have accelerated the reliance on digital health fuelling the expanded incorporation of mobile apps into healthcare services, particularly for the management of long-term conditions such as chronic diseases (CDs). However, the impact of health apps on outcomes for CD remains unclear, potentially owing to both the poor adoption of formal development standards in the design process and the methodological quality of studies. A systematic search of randomised trials was performed on Medline, ScienceDirect, the Cochrane Library and Scopus to provide a comprehensive outlook and review the impact of health apps on CD. We identified 69 studies on diabetes (n = 29), cardiovascular diseases (n = 13), chronic respiratory diseases (n = 13), cancer (n = 10) or their combinations (n = 4). The apps rarely adopted developmental factors in the design stage, with only around one-third of studies reporting user or healthcare professional engagement. Apps differed significantly in content, with a median of eight behaviour change techniques adopted, most frequently pertaining to the ‘Feedback and monitoring’ (91%) and ‘Shaping knowledge’ (72%) categories. As for the study methodologies, all studies adopted a traditional randomised control trial (RCT) design, with relatively short follow-ups and limited sample sizes. Findings were not significant for the majority of studies across all CD, with most RCTs revealing a high risk of bias. To support the adoption of apps for CD management, this review reinforces the need for more robust development and appropriate study characteristics to sustain evidence generation and elucidate whether study results reflect the true benefits of apps or a biased estimate due to unsuitable designs.