Cost and cost-effectiveness of mHealth interventions for the prevention and control of type 2 diabetes mellitus: A systematic review

It is the position of Dietitians Australia that clients can receive high-quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via telehealth. Outcomes of telehealth-delivered dietetic consultations are comparable to those delivered in-person, without requiring higher levels of additional training nor compromising quality of service provision. Dietitians Australia recommends that policy makers and healthcare funders broaden the recognition for telehealthdelivered dietetic consultations as a responsive and cost-effective alternative or complement to traditional in-person delivery of dietetic services. The successful implementation of telehealth can help to address health and service inequalities, improve access to effective nutrition services, and support people with chronic disease to optimise their diet-related health and well-being, regardless of their location, income or literacy level, thereby addressing current inequities. K E Y W O R D S chronic disease, diet, digital health, nutrition, telehealth 1 | BACKGROUND Nutrition-related chronic diseases are the leading cause of ill health in Australia. 1 Within the next 5 years, it is estimated that over 75% of Australian adults will be living with overweight or obesity. 2 One in two Australian adults have a chronic disease, with over seven million (35% of the Australian population) living with nutrition-related chronic disease, including type 2 diabetes, cardiovascular disease, obesity, diet-related cancer, chronic kidney disease and mental health conditions. 1,3 Australia, like many developed countries, has an ageing population, which presents a significant challenge for the healthcare system. Together these will drive up healthcare expenditure and present a multitude of additional societal, geographical and workforce challenges for the healthcare system to manage. 4 Telehealth-delivered nutrition consultations offer a flexible modality to provide effective and cost-effective medical nutrition therapy (MNT), regular monitoring and support to the large numbers of people in the community requiring dietetic services, in particular those with obesity 5 and nutrition-related chronic disease. 6,7 According to the World Health Organisation, the term "telehealth" refers to the remote delivery of health services using information and communication technologies to exchange health information, either synchronously Authors are members of the Dietitians Australia Telehealth Working Group

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“…The costs varied depending on the number and type of technologies employed that ranged from one technology to three. 71…”

Section: Economic Evaluation Of Telehealth-delivered Dietetic Consultationsmentioning

confidence: 99%

Dietitians Australia position statement on telehealth

Kelly

Allman‐Farinelli

Chen

et al. 2020

Nutrition & Dietetics

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“…Most previous studies compared interventions with conventional treatment with only a few comparing them with other tools such as automated messages or pedometer use [ 10 ]. The previous mobile health studies reporting on cost effectiveness used interventions with text messaging, video or phone calls, or an online glucose record keeper rather than interactive communication or tailored HCP feedback [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Personalized Type 2 Diabetes Management Using a Mobile Application Integrated with Electronic Medical Records: An Ongoing Randomized Controlled Trial

Lee

Yun

Cha

et al. 2021

IJERPH

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Controlling type 2 diabetes (T2DM) requires a comprehensive approach including patient education, self-monitoring of blood glucose, individualized behavioral strategies, and frequent contact with healthcare professionals (HCPs). We aimed to compare the efficacy of a personalized lifestyle intervention based on a mobile phone application with regular care in participants with T2DM. This is an ongoing randomized controlled open-label parallel-group trial with a target accrual of 282 participants, of which 181 have been enrolled to date. Participants are randomly assigned to one of three groups: (1) regular care; (2) mobile diabetes management; or (3) mobile diabetes management with HCP feedback. The mobile application is enabled to integrate with both electronic medical records (EMR) and a web-based diabetes management system for HCPs. It can send customized messages based on participants’ responses to lifestyle questionnaires administered at the baseline. The intervention period is 26 weeks followed by observation for 26 weeks. We evaluate the intervention’s features in order to assess its clinical utility and efficacy and compare outcomes with regular care considering relevant clinical factors, such as age, baseline HbA1c, etc. We expect our study to provide new evidence in support of customized mobile application tools for the management of T2DM.

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“…These needs include a practical and accessible tool for behavior change support that is compatible with daily family life [9][10][11]. Mobile health (mHealth) solutions offer easy access, use in daily family life, and integrated behavior change methods [12,13]. At present, the ideal mHealth platform for women post-GDM appears to be smartphone apps since they are frequently used for health purposes by women during the first few years post-GDM [14].…”

Section: Prior Work and Proposed Solutionmentioning

confidence: 99%

A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping Approach

Potzel¹,

Gar²,

Seißler³

et al. 2021

JMIR Mhealth Uhealth

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Background Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is associated with an increased risk for the development of cardiometabolic diseases. Behavioral interventions can reduce this risk, but current solutions insufficiently address the requirements for such a program. The systematic development of a scalable mobile health (mHealth) promotion program for mothers during the first years post-GDM may contribute to solving this problem. Objective The aim of this project was to systematically plan and develop a theory- and evidence-based mHealth intervention to change cardiometabolic risk behaviors in women during the first 5 years post-GDM that meets women’s expected standards of commercial health apps. Methods The intervention mapping steps 1 to 4 structured the systematic planning and development of the mHealth program described in this paper. Steps 1 and 2 led to a theory- and evidence-based logic model of change for cardiometabolic health. Based on this model, the prevention program was designed (step 3) and produced (step 4) in cooperation with industrial partners to ensure a high technological standard of the resulting smartphone app for the iPhone (Apple Inc). Step 4 included a user study with women during the first 5 years post-GDM once a beta version of the app (“TRIANGLE”) was available. The user study comprised 2 test rounds of 1 week (n=5) and 4 weeks (n=6), respectively. The tests included validated questionnaires on user acceptance, user logs, and think-alouds with semistructured interviews. Results The novel TRIANGLE app is among the first self-paced smartphone apps for individual habit change in the 3 lifestyle areas of physical activity, nutrition, and psychosocial well-being. The 3 core features—a challenge system, human coaching, and a library—address 11 behavioral determinants with 39 behavior change methods to support lifestyle changes. Participants in the user study showed a high acceptance, high perceived quality, and high perceived impact of the TRIANGLE app on their health behaviors. Participants tested the app regularly, used it intuitively, and suggested improvements. We then adapted the TRIANGLE app according to the insights from the user study before the full TRIANGLE program production. Conclusions The intervention mapping approach was feasible to plan and develop an innovative and scalable smartphone solution for women during the first 5 years post-GDM. The resulting TRIANGLE intervention has the potential to support behavior change for cardiometabolic disease prevention. However, the app needs further refinement and testing in clinical trials. Intervention mapping steps 5 (implementation plan) and 6 (evaluation plan) may support the integration of the TRIANGLE intervention into routine care. Trial Registration German Clinical Trials Register DRKS00012736; https://www.drks.de/DRKS00012736

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Cost and cost-effectiveness of mHealth interventions for the prevention and control of type 2 diabetes mellitus: A systematic review

Cited by 63 publications

References 49 publications

Dietitians Australia position statement on telehealth

Dietitians Australia position statement on telehealth

Personalized Type 2 Diabetes Management Using a Mobile Application Integrated with Electronic Medical Records: An Ongoing Randomized Controlled Trial

A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping Approach

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