**9. Type 1 diabetes mellitus**

**7.10. Psychosocial care**

42 Mobile Health Technologies - Theories and Applications

with the use of smartphones [104].

maybe provides an account to a forum [59].

**integration**

Patients with diabetes should regularly be assessed for their psychosocial well-being. Care should include assessment of their attitudes about the illness and prognosis, mood changes, satisfaction with quality of life, financial, social and emotional conditions, and possible psychiatric disorders (depression, distress, anxiety, eating disorders, dementia). Screening is

Telemedicine study researching depression and glycemic control in elderly showed a weak relationship between depression and HbA1C, but depression did not prospectively predict change in glycemic control [102]. In another study, web-based depression treatment for diabetics using cognitive behavior therapy was effective in reducing depressive symptoms, diabetes-specific emotional distress, while it had no benefit on glycemic control [103].

Telephone-based cognitive assessment (TBCA) was previously performed by conventional telephone. Because of better understanding of cognitive impairment, there is a possibility of more accurate TBCA. It needs more complex features of telephone which are easily achieved

**7.11. Personal health record (PHR)/electronic medical record (EMR) and social media**

and care. Terms EMR and EHR are often used interchangeably [106].

**8. Usability, accessibility, and acceptability of diabetes apps**

PHR is an internet-based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it [105]. Electronic medical record (EMR) is an electronic record with documents of patient's treatment in a clinic. Electronic health record (EHR) is a summary of individual's lifetime health status

Overall, 21% of commercial applications support synchronization of data with PHRs. Half of reviewed studies have integrated PHR with EMR and provide both patient and physician Web portal, whereas other included either a patient view or a clinician view of the EMR [56].

Social media integration is also emerging function of diabetes apps. It can help patients find similar users and communities in a dynamic fashion. But the majority of apps only provides links to their groups in well-known social networking sites such as Facebook and Twitter or

In a study of feasibility and acceptability of PDA-based (personal digital assistant-based) dietary self-monitoring of diabetes patients at the time of advent of the first smartphone high percentage of participants reported that they found PDA-monitoring useful, that the app was easy to use and that feedback was easily understandable [107]. In another study with PDAs, several limitations were found that may have contributed to perceived frustration including usability, data loss/errors (especially mistyped numbers) and time constraint (time consuming

recommended for depression and cognitive impairment for older than 65 [76].

We have to say some words about type 1 diabetes mellitus. We described until now mobile health interventions irrespective of the diabetes type. Because type 2 diabetes is much more widespread, studies included mostly or exclusively type 2 diabetes patients.

Young people with type 1 diabetes have many ideas and can help improve services and their own health-related quality of life. However, their lifestyle and their use of Web and smart‐ phones to cope the disease are not well researched [111].

A systematic review was carried out, focused on the ability of mobile health tools to grant patients with type 1 diabetes greater glycemic control. The tools investigated took a variety of forms and provided a number of different services to a diabetic patient. The indicator dem‐ onstrating the intervention to be successful was HbA1c and it was decreased in majority of studies, but not all values were statistically significant. In addition, prospective studies were predominantly used instead of randomized controlled trials [112].

Qualitative interviewing and exploring how young people with diabetes type 1 make use of technology in their lives and in relation to their condition and treatment, was made. On that basis, many suggestions to develop apps were found including issues such as alcohol and diabetes, hypoglycemia and diabetes, illness and diabetes, and Twitter use for diabetics. All listed suggestions were taken forward for prototyping, with alcohol and diabetes being developed as clinically approved app. There were also many other issues suggested, that were not prototyped [111].

In UK, a competition for teams including at least one young person with diabetes to develop an app, that might help this group of patients in preparation for their diabetes appointments, was conducted. After the development, other young people with diabetes were invited to choose, test and review new apps. The competition proved successful, showing the app designers and developers a need to develop a range of new functions [113].

Insulin calculator apps for patients with diabetes were scrutinized, because self-medication errors are recognized source of avoidable harm. Users are at risk of both catastrophic overdose and more subtle—suboptimal glucose control. In a research, considering input, only 59% calculators included clinical disclaimer and only 30% documented the calculation formu‐ la. 91% lacked numeric input validation, problems were also with calculation with missing values, ambiguous terminology, even with numeric precision. Considering output, 67% of calculators carries a risk of inappropriate output dose recommendation that either violated basic clinical assumptions or did not match a stated formula or correctly update in response to changing user input. It is advised, that health care professionals should exercise substantial caution in recommending unregulated dose calculators to patients and take care for proper education about possible threats [114].
