mHealth Interventions for Disadvantaged and Vulnerable People with Type 2 Diabetes

Curr Diab Rep. 2019 Nov 25;19(12):148. doi: 10.1007/s11892-019-1280-9.


Background: Mobile- and Internet-delivered (collectively, digital) interventions are widely used by persons with diabetes (PWD) to assist with self-management and improve/maintain glycemic control (hemoglobin A1c [A1c]). However, evidence concerning the acceptance and benefits of such interventions among disadvantaged/vulnerable PWD is still quite limited.

Purpose of review: We reviewed studies published from 2011-April 2019 evaluating the impact of diabetes self-management interventions delivered via mobile device and/or Internet on glycemic control of disadvantaged/vulnerable adults with type 2 diabetes (T2D). Included studies reported ≥ 50% of the sample having a low socioeconomic status and/or being a racial/ethnic minority, or living in a rural setting or low-/middle-income country (LMIC). We identified 21 studies evaluating a digital intervention among disadvantaged/vulnerable PWD.

Recent findings: Although many digital interventions found within-group A1c improvements (16 of 21 studies), only seven of the seventeen studies with a control group found between-group differences in A1c. Three studies found reductions in emergency room (ER) visits and hospitalizations. We synthesize this information, and provide recommendations for increasing access, and improving the design and usability of such interventions. We also discuss the role of human support in digital delivery, issues related to study design, reporting, economic value, and available research in LMICs. There is evidence suggesting that digital interventions can improve diabetes control, healthcare utilization, and healthcare costs. More research is needed to substantiate these early findings, and many issues remain in order to optimize the impact of digital interventions on the health outcomes of disadvantaged/vulnerable persons with diabetes.

Keywords: Disadvantaged; Disparities; HbA1c; Lifestyle intervention; Mobile; Technology interventions; Type 2 diabetes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adult
  • Cell Phone
  • Developing Countries
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / therapy*
  • Ethnicity
  • Humans
  • Internet
  • Minority Groups
  • Patient Acceptance of Health Care / statistics & numerical data
  • Poverty
  • Rural Population
  • Self-Management
  • Telemedicine* / economics
  • Telemedicine* / instrumentation
  • Telemedicine* / statistics & numerical data
  • Vulnerable Populations* / statistics & numerical data