title: Efficacy of Mobile Apps to Support the Care of Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health apps.
  
  
  OBJECTIVE
  The aim of our study was to evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist DM patients in treatment.
  
  
  METHODS
  We conducted searches in the electronic databases MEDLINE (Pubmed), Cochrane Register of Controlled Trials (CENTRAL), and LILACS (Latin American and Caribbean Health Sciences Literature), including manual search in references of publications that included systematic reviews, specialized journals, and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, patients with DM, and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager software version 5.3.
  
  
  RESULTS
  The literature search identified 1236 publications. Of these, 13 studies were included that evaluated 1263 patients. In 6 RCTs, there were a statistical significant reduction (P<.05) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (mean difference, MD -0.44; CI: -0.59 to -0.29; P<.001; I²=32%).The evaluation favored the treatment in patients who used apps without significant heterogeneity.
  
  
  CONCLUSIONS
  The use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care by contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly by reducing their fear of not knowing how to deal with potential hypoglycemic episodes that may occur.
authors.affiliation: Post Graduate Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Bráulio Cezar
authors.identifier: http://orcid.org/0000-0001-7514-2407
authors.initials: BC
authors.lastname: Bonoto
authors.affiliation: Institute of Biological Sciences and Health, Faculty of Odontology, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Vânia Eloisa
authors.identifier: http://orcid.org/0000-0002-0345-8522
authors.initials: VE
authors.lastname: de Araújo
authors.affiliation: Post Graduate Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.|SUS Collaborating Centre for Technology Assessment and Excellence in Health, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Isabella Piassi
authors.identifier: http://orcid.org/0000-0002-0568-6625
authors.initials: IP
authors.lastname: Godói
authors.affiliation: SUS Collaborating Centre for Technology Assessment and Excellence in Health, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.|Post Graduate Program in Public Health, Department Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Lívia Lovato Pires
authors.identifier: http://orcid.org/0000-0002-8921-515X
authors.initials: LL
authors.lastname: de Lemos
authors.affiliation: Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, Glasgow, United Kingdom.|Division of Clinical Pharmaclogy, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Brian
authors.identifier: http://orcid.org/0000-0001-6539-6972
authors.initials: B
authors.lastname: Godman
authors.affiliation: Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, Glasgow, United Kingdom.
authors.forename: Marion
authors.identifier: http://orcid.org/0000-0002-4046-629X
authors.initials: M
authors.lastname: Bennie
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Leonardo Mauricio
authors.identifier: http://orcid.org/0000-0001-9651-8485
authors.initials: LM
authors.lastname: Diniz
authors.affiliation: Post Graduate Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.|SUS Collaborating Centre for Technology Assessment and Excellence in Health, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Augusto Afonso Guerra
authors.identifier: http://orcid.org/0000-0001-5256-0577
authors.initials: AA
authors.lastname: Junior
keywords: diabetes mellitus; mobile applications; self-care; telemedicine