MHealth Applications, Older People and Type 2 Diabetes–a Detailed Review using Systematic Methodology

Introduction: Smartphone use among older people continues to increase and may provide a modern support mechanism for enhancing self-diabetes care and subsequently improving clinical outcomes. Objectives: We decided to produce a detailed review of the literature using a systematic evidenced-based approach and assess the benefits and limitations of their clinical efficacy and usability of mHealth applications (including smart phones) in older individuals (≥ 55 years) with type 2 diabetes in randomised Controlled Clinical Trials (RCTs) and to identify future research directions in this area. Methods: We identified 15 RCTs which matched our selection and inclusion criteria and using a highly descriptive approach, we reviewed changes in areas such as changes in HbA1c, blood pressure, lipid measures, physical activity levels, user satisfaction and self-behaviour changes. Results: Improvements in metabolic measures including HbA1c, body weight, physical activity, blood pressure and lipid profile were observed. Some improvements were noted in diabetes knowledge, patient satisfaction and personal behaviour and mHealth applications were noted to be useful in some cases of self-titration of hypoglycaemic medications but this was based on limited evidence only. Unfamiliarity, skills and technique acquisition with the mobile app were the main factors for dropouts. Conclusions: This review revealed that there was a lack of longer-term studies (>1 year), and few studies in people aged 70 years and over! In addition, few studies had a nurse or therapist support mechanism as part of the intervention. The review suggests the need for longer term intervention studies that involve personalised diabetes management programmes and an assessment of their cost-effectiveness.