OBJECTIVES: The prevalence of diabetes is rising. Medication adherence improve clinical outcomes in patients with diabetes. Studies have shown that daily reminders delivered though short message service result in better medication adherence. Mobile applications (apps) are also being developed with the aim of increasing adherence in diabetes. The objective of this review was to (1) identify applications available to measure adherence in diabetes, (2) review evidence available for the identified apps, and (3) assess future directions as well as potential challenges.

METHODS: Apps were identified through previous systematic literature reviews as well as searches on public databases. Additional targeted searches were conducted in EMBASE and clinical trials registries from database inception to June 11^th, 2018 to identify randomized controlled trials (RCTs) and real world evidence (RWE) available for each app, using key terms for apps and population. Data extraction elements included name, description of the app, type of study and overall conclusions related to medication adherence in diabetes.

RESULTS: In total, we identified 20 mobile apps that measured adherence in diabetes. Only four apps had RCTs and/or RWE for adherence in diabetes (Glucose Buddy, MyMedSchedule, Diabetes Under Control, MyT1DHero). The largest evidence was reported for Glucose Buddy (both RCT and RWE). Glucose Buddy was associated with increase in patient adherence to glucose monitoring but did not consistently improve other self-management activities (e.g. exercise). Users also identified challenges in using and navigating through the app. Evidence from MyMedSchedule, Diabetes Under Control, MyT1DHero is promising, however, results from ongoing RCTs and future RWE studies will help to understand their effectiveness on medication adherence in diabetes.

CONCLUSIONS: Current evidence of apps to improve adherence in diabetes is lacking. Future studies should be performed in larger groups with a longer follow-up period to assess the advantage of using apps to improve adherence in diabetes.