•  
  •  
 

Abstract

Background: Managing diabetes in the elderly is challenging due to limited access to health education and support. While mHealth tools have improved self-management and glycaemic control, evidence in older populations is limited. This study evaluated the impact of a mobile app and telephone follow-up on diabetes knowledge, health behaviours, and HbA1C levels in elderly individuals with diabetes.

Methods: A quasi-experimental study with a non-equivalent control group design was conducted. A total of 210 elderly individuals with diabetes were recruited and assigned to one of three groups: a mobile application group, a telephone follow-up group, and a control group (70 participants per group). Chi-square tests, one-way ANOVA, and paired t-tests were used to analyze the hypothesis.

Results: Before the intervention, no statistically significant differences in diabetes knowledge, health behaviours, or HbA1C levels were observed among the three groups (P > 0.05). The post-intervention results showed the mobile application group had significantly higher scores in diabetes knowledge (8.96 ± 2.32) and health behaviours (80.64 ± 7.23) compared to the telephone follow-up and control groups (P < 0.001). Similarly, the mobile application group had significantly lower HbA1C levels (7.19 ± 0.80) than the other groups (P < 0.001).

Conclusion: mHealth notably outperformed telephone follow-up and standard care, significantly boosting diabetes knowledge, self-care behaviours, and HbA₁c in elderly patients. Integrating such apps into routine management could enhance outcomes, with future research needed on long-term adherence and scalability.

Keywords: Digital health, mHealth intervention, Elderly diabetes management, Self-care behaviors, Glycaemic control, Telemedicine, Thailand

References

[1] World Health Organization [WHO]. Diabetes. Geneva: WHO;2021 [cited 2025 Feb 11]. Available from, https://www.who.int/news-room/fact-sheets/detail/diabetes.

[2] American Diabetes Association. Standards of medical care in diabetes 2021. Diabetes Care 2021;44(1):S7e14. https://doi.org/10.2337/dc21-S001.

[3] Ristau RA, Yang J, White JR. Mobile health applications and diabetes management: a review of current strategies and future directions. Curr Diabetes Rep 2022;22(9):87e102. https://doi.org/10.1007/s11892-022-01492-2.

[4] Pal K, Eastwood SV, Michie S, Farmer AJ, Barnard ML, Peacock R, et al. Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 2013 Mar 28;2013(3):CD008776. https://doi.org/10.1002/14651858.CD008776.pub2.

[5] Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth interventions to support self-management of long-term conditions: a systematic metareview of diabetes, heart failure, asthma, chronic obstructive pulmonary disease, and cancer. J Med Internet Res 2017;19(5):e172. https://doi.org/10.2196/jmir.6688.

[6] Rees S, Williams A. Promoting and supporting self-management for adults living in the community with physical chronic illness: a systematic review of the effectiveness and meaningfulness of the patient-practitioner encounter. JBI Libr Syst Rev 2009;7(13):492e582. https://doi.org/10.11124/=01938924-200907130-00001.

[7] Choi W, WangS, LeeY, OhH,ZhengZ. Asystematic review of mobile health technologies to support self-management of concurrent diabetes and hypertension. J Am Med Inf Assoc 2020 Jun 1;27(6):939e45. https://doi.org/10.1093/jamia/ocaa029.

[8] Bashshur RL, Shannon GW, Smith BR, Alverson DC, Antoniotti N, Barsan WG, et al. The empirical foundations of telemedicine interventions for chronic disease management. Telemed J e Health 2014;20(9):769e800. https://doi.org/10.1089/tmj.2014.9981.

[9] Jeffrey B, Bagala M, Creighton A, Leavey T, Nicholls S, Wood C, et al. Mobile phone applications and their use in the self-management of Type 2 Diabetes Mellitus: a qualitative study among app users and non-app users. Diabetol Metab Syndr 2019 Oct 16;11:84. https://doi.org/10.1186/s13098-019-0480-4.

[10] Boels AM, Rutten G, Zuithoff N, de Wit A, Vos R. Effectiveness of diabetes self-management education via a smartphone application in insulin treated type 2 diabetes patients- design of a randomised controlled trial ('TRIGGER study'). BMC Endocr Disord 2018 Oct 22;18(1):74. https://doi.org/10.1186/s12902-018-0304-9.

[11] Azizi Z, Broadwin C, Islam S, Schenk J, Din N, Hernandez MF, et al. Digital health interventions for heart failure management in underserved rural areas of the United States: a systematic review of randomized trials. J Am Heart Assoc 2024 Jan 16;13(2):e030956. https://doi.org/10.1161/JAHA.123.030956.

[12] Centers for Disease Control and Prevention. National diabetes statistics report 2020: estimates of diabetes and its burden in the United States [cited 2025 Feb 11]. Available from: https://www.cdc.gov/diabetes/php/data-research/index.html; 2021.

[13] Nutbeam D. The evolving concept of health literacy. Soc Sci Med 2008;67(12):2072e8. https://doi.org/10.1016/j.socscimed.2008.09.050.

[14] Walker RJ, Smalls BL, Hernandez-Tejada MA. Social determinants of health and diabetes outcomes: a systematic review. Health Soc Care Community 2015;23(6):591e605. https://doi.org/10.1111/hsc.12255.

[15] Huang Z, Tao H, Meng Q, Jing L. Effectiveness of telemedicine for controlling HbA1c in diabetes patients: a systematic review and meta-analysis. J Telemed Telecare 2019;25(7): 393e402. https://doi.org/10.1177/1357633X18816844.

[16] Baptista S, Wadley G, Bird D, Oldenburg B, Speight J, Gibson O. User experiences with a type 2 diabetes coaching app: a qualitative study. JMIR Diabetes 2018;3(1):e8. https:// doi.org/10.2196/diabetes.8651.

[17] Fernandez C, Vicente MA, Guilabert M, Carrillo I, Mira JJ. Developing a mobile health app for chronic illness management: Insights from focus groups. Digit Health 2023 Nov 1;9:20552076231210662. https://doi.org/10.1177/20552076231210662.

[18] Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res 2015 Feb 24;17(2):e52. https://doi.org/10.2196/jmir.3951.

[19] Hou C, Xu Q, Diao S, Hewitt J, Li J, Carter B. Mobile phone applications and self-management of diabetes: a systematic review with meta-analysis, meta-regression of 21 randomized trials and GRADE. Diabetes Obes Metabol 2018 Aug;20(8):2009e13. https://doi.org/10.1111/dom.13307.

[20] UK Prospective Diabetes Study Group. Intensive bloodglucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352(9131):837e53. https://doi.org/10.1016/S0140-6736(98)07019-6.

[21] Garavand A, Mohseni M, Asadi H, Etemadi M, Moradi-Joo M, Moosavi A. Factors influencing the adoption of health information technologies: a systematic review. Electron Physician 2016 Aug 25;8(8):2713e8. https://doi.org/10.19082/2713.

[22] Dennison L, Morrison L, Conway G, Yardley L. Opportunities and challenges for smartphone applications in supporting health behavior change: qualitative study. J Med Internet Res 2013 Apr 18;15(4):e86. https://doi.org/10.2196/jmir.2583.

[23] Lee YY, Zhang CJ, Yip BH, Tsang SL, Yeoh EK, Griffiths SM. Effectiveness of mHealth interventions for chronic disease management in sub-Saharan Africa: a systematic review. BMJ Glob Health 2018;3(4):e000912. https://doi.org/10.1136/bmjgh-2018-000912.

[24] Kim H, Lee S. Health literacy-sensitive diabetes self-management interventions: a systematic review and meta-analysis. Worldviews Evidence-Based Nurs 2016 Aug;13(4): 324e33. https://doi.org/10.1111/wvn.12157.

[25] Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. J Acad Nutr Diet 2015 Aug;115(8):1323e34. https://doi.org/10.1016/j.jand.2015.05.012.

[26] Quinn CC, Swasey KK, Crabbe JC, Shardell ML, Terrin ML, Barr EA, et al. Mobile diabetes intervention for glycemic control: meta-analysis of randomized controlled trials. J Med Internet Res 2018;20(3):e10185. https://doi.org/10.2196/10185.

[27] Arambepola C, Ricci-Cabello I, Manikavasagam P, Roberts N, French DP, Farmer A. The impact of automated brief messages and reminders for the prevention and management of chronic diseases. J Med Internet Res 2020;22(9): e20742. https://doi.org/10.2196/20742.

[28] Klonoff AN, Andy Lee WA, Xu NY, Nguyen KT, DuBord A, Kerr D. Six digital health technologies that will transform diabetes. J Diabetes Sci Technol 2023 Jan;17(1):239e49. https://doi.org/10.1177/19322968211043498.

[29] Dhediya R, Chadha M, Bhattacharya AD, Godbole S, Godbole S. Role of telemedicine in diabetes management. J Diabetes Sci Technol 2023 May;17(3):775e81. https://doi.org/10.1177/19322968221081133.

[30] Morrison J, Akter K, Jennings H, Ahmed N, Kumer Shaha S, Kuddus A, et al. Learning from a diabetes mHealth intervention in rural Bangladesh: what worked, what did not and what next? Glob Public Health 2022 Jul;17(7):1299e313. https://doi.org/10.1080/17441692.2021.1923776.

[31] Dsouza SM, Venne J, Shetty S, Brand H. Identification of challenges and leveraging mHealth technology, with needbased solutions to empower self-management in type 2 diabetes: a qualitative study. Diabetol Metab Syndr 2024 Jul 30;16(1):182. https://doi.org/10.1186/s13098-024-01414-9.

[32] Quevedo Rodríguez A, W€agner AM. Mobile phone applications for diabetes management: a systematic review. Endocrinol Diabetes Nutr (Engl Ed) 2019 May;66(5):330e7. https://doi.org/10.1016/j.endinu.2018.11.005. English, Spanish.

[33] Giger OF, Pfitzer E, Mekniran W, Gebhardt H, Fleisch E, Jovanova M, et al. Digital health technologies and innovation patterns in diabetes ecosystems. Digit Health 2025 Feb 5;11: 20552076241311740. https://doi.org/10.1177/20552076241311740.

[34] DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol 2004; 23(2):207e18. https://doi.org/10.1037/0278-6133.23.2.207.

[35] Supramaniam P, Beh YS, Junus S, Devesahayam PR. Exploring mHealth app utilization for diabetes self-management: survey insights from a northern district in Malaysia. BMC Public Health 2024 Dec 19;24(1):3542. https://doi.org/10.1186/s12889-024-21056-w.

[36] Pal K, Eastwood SV, Michie S, Farmer AJ, Barnard ML, Peacock R, et al. Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 2020;12:CD012224. https://doi.org/10.1002/14651858.CD012224.pub2.

[37] Camargo-Plazas P, Robertson M, Alvarado B, PareGC, Costa IG, Duhn L. Diabetes self-management education (DSME) for older persons in western countries: a scoping review. PLoS One 2023 Aug 9;18(8):e0288797. https://doi.org/10.1371/journal.pone.0288797.

[38] Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. J Diabetes Sci Technol 2017 Sep;11(5):1015e27. https://doi.org/10.1177/1932296817713506.

[39] Bashshur RL, Shannon GW, Smith BR, Alverson DC. The empirical foundations of telemedicine interventions for chronic disease management. Telemed e-Health 2016;22(5): 342e75. https://doi.org/10.1089/tmj.2016.0102.

[40] Gardner DSL, Saboo B, Kesavadev J, Mustafa N, Villa M, Mahoney E, et al. Digital health technology in diabetes management in the Asia-Pacific Region: a narrative review of the current scenario and future outlook. Diabetes Ther 2025 Mar;16(3):349e69. https://doi.org/10.1007/s13300-02501692-0.

[41] Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JGF, Stewart S. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev 2017;3:CD007228. https://doi.org/10.1002/14651858.CD007228.pub3.

[42] Stampe K, Kishik S, Müller SD. Mobile health in chronic disease management and patient empowerment: exploratory qualitative investigation into patient-physician consultations. J Med Internet Res 2021 Jun 15;23(6):e26991. https://doi.org/10.2196/26991.

[43] Kruse CS, Lee K, Watson JB, Lobo LG, Stagg-Elliott MA. Factors associated with adoption of health information technology: a conceptual model based on literature review. Telemed e-Health 2019;25(6):1e9. https://doi.org/10.1089/tmj.2018.0142.

Download

Share

COinS