Evaluating Effectiveness of mHealth Applications for Older Adults with Diabetes: Meta-Analysis of Randomized Controlled Trials (Preprint)
Authors: Azevedo Renato Ferreira Leitao , Varzino Michael , Steinman Erika , Rogers Wendy A. 
Published: August 2024

BACKGROUND

The global population is aging rapidly, with projections indicating a doubling of older adults by 2050. Among the chronic conditions affecting this demographic, diabetes stands out due to its prevalence and impact on health. Mobile health (mHealth) app interventions show promise in improving health outcomes, leveraging the widespread adoption of smartphones among older adults.

OBJECTIVE

This meta-analysis aimed to evaluate the effectiveness of mHealth apps specifically tested for older adults with diabetes. It addresses the gap in existing literature by focusing on this age group, aiming to provide insights into the benefits and challenges of these technologies.

METHODS

A meta-analysis of randomized controlled trials (RCTs) was conducted, across major databases using PRISMA guidelines, to examine the effectiveness of mHealth apps for improving older adults’ diabetes outcomes. Primary outcomes included changes in glycated hemoglobin (HbA1c), fasting blood sugar (FBS), and medication adherence levels. We retrieved of 4247 papers, of which 257 were moved to full review, and 7 identified following our criteria. Papers were excluded if the study was not an RCT, did not examine the effect of mHealth apps, or was not conducted with older adults. We provide a mixed-methods perspective, pairing the effect sizes in the literature with a review of features included in these apps, allowing for a more comprehensive comparison and reference for future RCT interventions with similar technologies designed for older adults.

RESULTS

Overall, our results indicated that mHealth app interventions can be effective for managing blood glucose in older adult populations. Seven RCTs met the inclusion criteria, involving a total of 490 participants. The meta-analysis revealed a significant reduction in glycated hemoglobin (HbA1c) levels (Hedge's g: -0.40, 95% CI [-0.75 to -0.06]) among older adults using mHealth apps. Limited data on fasting blood sugar (FBS) and medication adherence showed positive trends, echoing the main HbA1c findings.

CONCLUSIONS

mHealth apps demonstrate effectiveness in improving glycemic control among older adults with diabetes, highlighting their potential as tools for health management in this demographic. Our effect sizes were comparable with other meta-analyses conducted across different aging groups, suggesting that diabetes mHealth apps can be as effective for older adults compared to younger cohorts. Some of our data suggests that the effectiveness of mHealth apps might decrease over trial time. These findings underscore the need for further research to refine these interventions and optimize their impact on older adults' health outcomes. We describe each RCT intervention and evaluate the risk of bias and the app components that could relate to the app effectiveness to inform the design of other diabetes management RCT interventions, and more broadly, the design of other mHealth tools for older adults.