The potential of mHealth for diabetic patients

To be able to check the reliability of the published studies, different databases have been used to find studies on mHealth interventions on diabetics (MEDLINE, EMBASE, CINAHL, CDSR, DARE and HTA), of which a representative selection was made of each one.

To identify the methodological quality of the selected studies, AMSTAR was used, which is a validated instrument that uses 11 criteria for assessing suitability and impartiality in designing and performing a study. The studies were separated by level: low or with “important methodological limitations”; medium or with “moderate methodological limitations” (between 4 and 7) or high and “without methodological limitations” (between 8 and 11). Of the 989 identified studies, a total of 15 were selected.

The reasons for not passing the AMSTAR criteria were:

• The sources of support or conflicts of interest were not assessed.
• Evidence was not provided of a protocol published before.
• The grey literature (minutes of congresses, etc.) was not reviewed.
• Search for studies only in English.
• No details were given of the collaborators taking part in the study.
• No details were given of the process used in selecting studies or extracting data.
• Conclusions were reached without bearing in mind the scientific quality of the trials included.

Of these 15 studies, 6 studies can be classified as focused on the effects of mHealth for diabetic patients, 4 dealt with remote monitoring interventions and 5 investigated the effects of mHealth on different chronic pathologies, including diabetes. The mHealth interventions were made by SMS, mobile applications, glucose measurers, secure webs, etc.

The most common methodology is the sending of glucose in blood measurements and the possibility of receiving support in self-managing the disease via SMS. Most studies combine the sending of glucose in blood measurements with adjustment of medication or recommendations for a healthy lifestyle. Half of the studies offer patients educational support, whereas in all the main goal was glycaemic control.

In the glycaemic control, the benefits of the use of SMS were shown, demonstrating that mobile interventions for sending glucose in blood measurements improve their monitoring and control.

With the studies in hand, the conclusion is that the studies published in the last 18 years generally involve a low methodological level with limitations and a risk of bias in the results. There were also seen not to be studies distinguishing the two existing types of diabetes, but that they rather put them together in the same type without considering their characteristics.

However, if we focus on the more qualitative studies, it is shown that the use of mobile phones for the interventions is of help in glycaemic control. However, although it is necessary to make a study focused on real time and multimedia impact (strategies of gamification, social networks), as it is the young who use these technologies. It is also necessary to study the apps on the Google and Apple Market, as many of the applications used in the studies are not available to the public, but rather only to the research centres.

Finally, the impact of mHealth should also be analysed in the use of healthcare services, as the results could help in considering their economic viability and they could be used in the new health policies.