The role of smartphone applications in preventing Type 2 diabetes mellitus: a systematic literature review, meta-analysis and a qualitative study

Background: Prevention of Type 2 diabetes among high risk patients is required to reduce the burden of disease. Mobile technologies offer new possibilities to support patients with behaviour change and lifestyle improvement to prevent type 2 diabetes. 

Aims: To review the evidence on smartphone application (app) interventions for reducing risk factors for type 2 diabetes and understand patient perspectives on their use. 

Methods: A systematic literature review, meta-analysis and a qualitative study were conducted. The review included experimental and qualitative studies evaluating apps for prevention of type 2 diabetes, focusing on any health- related measures or patient perspectives. The qualitative study comprised semi-structured interviews with patients at risk of developing type 2 diabetes to understand their perspectives on using apps in reducing the risk factors. Transcripts were thematically analysed. 

Results: The systematic review showed that the use of apps in type 2 diabetes prevention is still in an early stage of research. Fifteen articles were included, with most studies being randomized controlled trials and quasi-experimental. Reduction in weight and body mass index were the most consistent finding among experimental studies. Qualitative findings indicated that the most preferred app features included automated self- monitoring (e.g. tracking physical activity), education and personalised feedback. The conducted qualitative study expanded on these results by highlighting the relevance of app features supporting healthy lifestyle, and by reinforcing that patient-clinician communication, automated tracking, and personalised educational support are essential to improve knowledge, motivation, and self-management. 

Conclusion: Smartphone health applications seem to be effective in mitigating the risk factors for developing type 2 diabetes. Findings from this thesis suggest smartphone health applications may be efficacious in improving risk factors associated with type 2 diabetes but further research is needed, particularly robust randomised controlled trials. Highly valued features by patients included automated and personalized self-monitoring and feedback, tailored educational content, and patient-clinician communication.