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. 2020 Aug 4;8(8):e15779.
doi: 10.2196/15779.

Effectiveness of Mobile App-Assisted Self-Care Interventions for Improving Patient Outcomes in Type 2 Diabetes and/or Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Kaifeng Liu  1 , Zhenzhen Xie  1 , Calvin Kalun Or  1
Affiliations

Effectiveness of Mobile App-Assisted Self-Care Interventions for Improving Patient Outcomes in Type 2 Diabetes and/or Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Kaifeng Liu et al. JMIR Mhealth Uhealth. .

Erratum in

Abstract

Background: Mobile app-assisted self-care interventions are emerging promising tools to support self-care of patients with chronic diseases such as type 2 diabetes and hypertension. The effectiveness of such interventions requires further exploration for more supporting evidence.

Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to examine the effectiveness of mobile app-assisted self-care interventions developed for type 2 diabetes and/or hypertension in improving patient outcomes.

Methods: We followed the Cochrane Collaboration guidelines and searched MEDLINE, Cochrane Library, EMBASE, and CINAHL Plus for relevant studies published between January 2007 and January 2019. Primary outcomes included changes in hemoglobin A1c (HbA1c) levels, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Changes in other clinical-, behavioral-, knowledge-, and psychosocial-related outcomes were included as secondary outcomes. Primary outcomes and objective secondary outcomes that were reported in at least two trials were meta-analyzed; otherwise, a narrative synthesis was used for data analysis.

Results: A total of 27 trials were identified and analyzed. For primary outcomes, the use of mobile app-assisted self-care interventions was associated with significant reductions in HbA1c levels (standardized mean difference [SMD] -0.44, 95% CI -0.59 to -0.29; P<.001), SBP (SMD -0.17, 95% CI -0.31 to -0.03, P=.02), and DBP (SMD -0.17, 95% CI -0.30 to -0.03, P=.02). Subgroup analyses for primary outcomes showed that several intervention features were supportive of self-management, including blood glucose, blood pressure, and medication monitoring, communication with health care providers, automated feedback, personalized goal setting, reminders, education materials, and data visualization. In addition, 8 objective secondary outcomes were meta-analyzed, which showed that the interventions had significant lowering effects on fasting blood glucose levels and waist circumference. A total of 42 secondary outcomes were narratively synthesized, and mixed results were found.

Conclusions: Mobile app-assisted self-care interventions can be effective tools for managing blood glucose and blood pressure, likely because their use facilitates remote management of health issues and data, provision of personalized self-care recommendations, patient-care provider communication, and decision making. More studies are required to further determine which combinations of intervention features are most effective in improving the control of the diseases. Moreover, evidence regarding the effects of these interventions on the behavioral, knowledge, and psychosocial outcomes of patients is still scarce, which warrants further examination.

Keywords: hypertension; mobile app; self-care; type 2 diabetes.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow diagram of the study selection process.
Figure 2
Figure 2
Risk of bias of the 27 trials.
Figure 3
Figure 3
Risk of bias for each trial.
Figure 4
Figure 4
Forest plots for hemoglobin A1c (top), systolic blood pressure (middle), and diastolic blood pressure (bottom).
See this image and copyright information in PMC

References

    1. Diabetes and high blood pressure. Blood Pressure UK. 2008. [2020-02-26]. http://www.bloodpressureuk.org/BloodPressureandyou/Yourbody/Diabetes .
    1. Gress TW, Nieto FJ, Shahar E, Wofford MR, Brancati FL. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. N Engl J Med. 2000 Mar 30;342(13):905–912. doi: 10.1056/NEJM200003303421301. - DOI - PubMed
    1. Cheung BMY, Wat NMS, Tso AWK, Tam S, Thomas GN, Leung GM, Tse HF, Woo J, Janus ED, Lau CP, Lam TH, Lam KSL. Association between raised blood pressure and dysglycemia in Hong Kong Chinese. Diabetes Care. 2008 Sep;31(9):1889–1891. doi: 10.2337/dc08-0405. http://europepmc.org/abstract/MED/18556342 dc08-0405 - DOI - PMC - PubMed
    1. Bayliss EA, Steiner JF, Fernald DH, Crane LA, Main DS. Descriptions of barriers to self-care by persons with comorbid chronic diseases. Ann Fam Med. 2003;1(1):15–21. http://www.annfammed.org/cgi/pmidlookup?view=long&pmid=15043175 - PMC - PubMed
    1. El-Gayar O, Timsina P, Nawar N, Eid W. Mobile applications for diabetes self-management: status and potential. J Diabetes Sci Technol. 2013;7(1):247–262. http://europepmc.org/abstract/MED/23439183 - PMC - PubMed

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