The evidence for using mHealth technologies for diabetes management in low- and middle-income countries
Worldwide, diabetes is a significant cause of death and disability, accounting for approximately 29 million years of life lost (YLLs) in 2016. Low- and middle-income countries (LMICs) are particularly challenged by diabetes, with fewer patients achieving control of their condition, younger average age of onset, escalating prevalence rates, coupled with healthcare system shortages. Mobile health (mHealth) technologies have been proposed as cost-effective, widely accessible strategies for overcoming many of the barriers to effective diabetes management. mHealth interventions enable the real-time exchange of information between patients and healthcare providers, allowing for responsive and timely treatment recommendations, which has the potential to increase the capacity of patients in self-managing their conditions. Previous reviews of mHealth interventions for diabetes care have found positive effects on key diabetes outcomes. However, to date, all reviews have largely reported on studies conducted in high-income countries (HICs). The effectiveness of these interventions in LMICs is less clear. This review provides an assessment of the published evidence for the effectiveness of mHealth interventions on key diabetes outcomes in LMICs. The electronic databases PubMed, Ovid Medline, CINAHL and SCOPUS were comprehensively searched to identify eligible studies. Only randomized controlled trials (RCTs), controlled trials, randomized head-to-head trials and systematic reviews with meta-analyses were eligible for inclusion. The database search yielded 1,019 unique records. Nine studies were included in the final review. Six studies reported significant, positive effects of the intervention on at least one key diabetes outcome measure. Whilst few studies evaluated the intervention on behavioural outcomes, there was an indication that mHealth interventions can elicit positive change on key diabetes self-care behaviours such as medication adherence. The review found promising but limited evidence for the effectiveness of mHealth interventions for improving glycaemic control in LMICs. It is timely that researchers examine the effectiveness of various mHealth interventions for diabetes care using rigorous study designs, scalable interventions, measuring both clinical and behavioural diabetes-related outcomes in LMICs.