Effect of a structured educational intervention delivered through a mobile application on glycated haemoglobin and self-efficacy in adolescents with type 1 diabetes mellitus: a systematic review and meta-analysis.

Abstract

Type 1 diabetes mellitus (T1DM) is a chronic illness affecting children and adolescents worldwide. Mobile health apps (MHAs) are increasingly used to deliver structured educational interventions (SEI) aimed at reducing glycated haemoglobin (HbA1c), enhancing self-efficacy and self-management in adolescents with T1DM. This review and meta-analysis assessed the effectiveness of SEI via MHAs on HbA1c and self-efficacy in adolescents with T1DM. Systematic review and meta-analysis. PubMed, Pak Medinet, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Wiley Online Library and host database Offshore Vessel Inspection Database (OVID) were searched from 1 January 2013 to 30 December 2023. Randomised controlled trials and quasi-experimental studies (QES) conducted in adolescents aged 10-19 years with T1DM that evaluated the effectiveness of SEIs delivered through mobile app on HbA1c and self-efficacy were included. Two independent reviewers screened the abstracts and articles by assuring standardised methods. Quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Tools for randomised controlled trials (RCTs) and QESs. The meta-analysis was conducted using a random-effects model. Eight studies met the inclusion criteria, with 555 adolescents aged 10-19 years. The study duration ranged from 7 to 48 weeks. Meta-analysis showed no significant difference in HbA1c at 3 months between the MHAs and control groups (Hedge's g: -0.03, 95% CI: -0.37 to 0.31, p=0.86). Study heterogeneity was moderate (I²=45%) with no publication bias (Begg's test p>0.99). Self-efficacy outcomes were inconclusive, with only one RCT reporting improvement in the intervention group and two QES studies showing mixed results. SEI via MHAs did not significantly affect HbA1c levels in adolescents with T1DM compared with those in the controls. We recommend conduction of well-designed RCTs with larger sample sizes, standardised measurements and tailored educational components to better determine the effectiveness of SEI via MHAs in adolescents. CRD42024537942.