Consumer health applications effect on diet and exercise behaviours inpeople with diabetes mellitus, type 2

Abstract

Background: Despite growing utilization of mobile phones and websites for consumers seeking health care advice, the area is largely understudied. A niche market for these applications is in diabetes care. Since diabetes is a chronic condition requiring daily monitoring it is a good candidate for consumer health informatics and especially interactive websites and mobile phone applications.

As the obesity epidemic continues, so too the prevalence of type 2 diabetes continues to rise. This chronic condition can lead to major complications and high medical cost. It is on the rise in countries all over the world, and beginning to impact people at younger ages. Low cost interventions are being explored to mitigate these complications and cost.

Objective: To examine the effectiveness of consumer health informatics, such as websites, personal digital assistants, and mobile phone applications that claim to help people with diabetes self-monitor diet and exercise behaviours to lose weight.

Methods: A search for relevant literature was conducted using PUBMED, Cochrane, and IEEE Xplore, with the search terms: (mhealth OR mobile health OR phone OR web* OR ehealth OR internet OR ICT) AND diabetes AND (diet* OR exercise OR physical activity). Also, a bibliographic search was done to identify any studies that were missed in the initial search. The search was not limited to any date range, but articles were identified from the time period of September 2000 through April 2012. Only articles in English were included.

Studies were included if the program included an interactive logging feature for diet and/or physical activity. Studies that looked at type 1 disbetes were excluded.

Results: A total of 10 original studies were found that met the inclusion criteria. Including 2 qualitative design, 1 randomized trial, and 7 randomized control trials. There was a great deal of heterogeneity among the studies. Delivery methods varies, studies including the following are: *  Mobile device only: 3 *  Website only: 6 *  Website plus mobile device: 1

Many different outcome measures were used across the studies including: behavioural, physiological, psychosocial, as well as usability and satisfaction. Overall, adherence and follow up were low. Dietary tracking generally appears not to be as effective as broad goals such as, “each more fruits and vegetables”. Exercise tracking was more effective at increasing physical activity. Message boards and peer support did not show an increase in effectiveness, but personal online coaches and personalized emails showed promising results. Usability and satisfaction was high in those that reported it, but the large number of dropouts are not considered in this.

Conclusions: At this time, consumer health informatics does not seem to be an effective solution in facilitating significant behavior change for people who have type 2 diabetes. Future programs should look at ways to increase adherence and usage of the programs because the people who did use the programs daily benefited more than sporadic users.

Components that showed promising results are access to a personal online coach, personalized weekly emails, integration with a pedometer that automatically uploads to a tracking program, and broader food related goals.

Further testing is necessary to determine if this type of intervention is effective.