Effectiveness of mobile health solutions in lowering glycated hemoglobin and resulting economic effects-a review of the current literature

Background: In recent years, a variety of innovative solutions have been introduced that are designed to improve adherence to blood sugar testing among patients with diabetes, lower glycated hemoglobin (HbA_1c), and decrease complications associated with diabetes mellitus. The value of lowering HbA_1c in preventing long-term complications of diabetes is broadly recognized. The purpose of this review is to provide an overview of the peer-reviewed literature documenting both the efficacy of mobile health (mHealth) solutions in improving adherence and lowering HbA_1c, along with the impact of lowering HbA_1c on near-term cost and complications of diabetes. Methodology: An extensive search of Index Medicus was performed in order to identify studies documenting the effectiveness of mHealth solutions in reducing HbA_1c and documenting the effectiveness of reducing HbA_1c in lowering near-term medical costs. Results: Six randomized controlled trials were identified in which the use of mobile monitoring solutions for blood glucose was tested against standard care. All demonstrated a reduction in HbA_1c, ranging from 0.35-1.9 percentage points. Ten studies, primarily longitudinal and retrospective in nature, were identified, which evaluated the effectiveness of HbA_1c reduction on reducing near-term medical costs. Overall, moderate reduction in HbA_1c appears to reduce medical costs by 10 % on average in commercially insured populations and 7 % on average in Medicare-age populations. Conclusions: mHealth interventions for diabetes show promise in reducing HbA_1c across multiple settings and achieving this clinical result is likely to result in reduction of near-term medical costs.