# Digital Health Interventions in Children and Adolescents With Type 1 Diabetes Mellitus and Their Impact on Clinical and Behavioral Outcomes: Scoping Review

## TL;DR

This review explores how mobile health apps help children and teens manage type 1 diabetes, focusing on their impact on blood sugar control and behavior.

## Contribution

The study is the first scoping review to systematically analyze mHealth apps for pediatric T1DM through the lens of social cognitive theory.

## Key findings

- Nine studies reported hemoglobin A1c improvements, with four showing statistically significant results.
- Most apps incorporated self-efficacy and behavioral capability from social cognitive theory.
- Interventions using multiple behavioral constructs showed greater potential for sustained behavior change.

## Abstract

Effective self-management of type 1 diabetes mellitus (T1DM) by children and adolescents remains challenging despite advances in insulin delivery and glucose monitoring technologies. Mobile health (mHealth) interventions have emerged as promising tools to support pediatric diabetes care. However, their clinical impact and the behavioral mechanisms through which they operate—particularly those grounded in social cognitive theory (SCT)—are not well established.

This scoping review assesses mHealth apps focused on the management of T1DM in the pediatric population and looks into the underlying behavioral frameworks in accordance with SCT.

We conducted a scoping review of 5 databases (PubMed, Cochrane Library, EMBASE, CINAHL, and Scopus) for English-language studies published between January 2000 and July 2024. Eligible studies evaluated mHealth apps for children and adolescents with T1DM (≤18 years) and reported outcomes including glycemic control, self-efficacy, adherence, self-management, or quality of life. Data were extracted and synthesized according to clinical outcomes and the presence of SCT constructs, namely self-efficacy, behavioral capability, expectations, reinforcements, and reciprocal determinism.

Of 5607 studies screened, 12 met the inclusion criteria. These comprised 4 randomized controlled trials, 4 pilot studies, 2 pre-post intervention studies, 1 retrospective cohort study, and 1 double crossover trial. App features included glucose logging, insulin tracking, bolus calculators, reminders, gamification, and structured educational content. Hemoglobin A1c (HbA1c) outcomes were reported by 9 studies; 4 demonstrated statistically significant improvements, while the others reported stability or no change. Several studies also reported improvements in treatment adherence and perceived self-efficacy. Of the 12 studies, 11 incorporated at least 1 SCT construct, with most integrating behavioral capability and self-efficacy as core components. Interventions using multiple SCT constructs showed greater promise for supporting sustained behavior change.

mHealth apps for pediatric T1DM are complex behavioral interventions that often leverage key principles of SCT to promote effective self-management. Although the evidence supports modest benefits in glycemic control and behavioral outcomes, heterogeneity in study design and outcome measurement limits broader generalizability. Future research should prioritize the development and evaluation of SCT-informed digital interventions with standardized outcome frameworks to improve pediatric diabetes care.