Gamified mobile health interventions for self-management in adolescents and young adults with type 1 diabetes mellitus: A narrative review

This narrative review synthesizes current evidence on how gamified mobile health (mHealth) platforms influence health, behavioral, and psychosocial outcomes in adolescents and young adults (AYA) with Type 1 Diabetes Mellitus (T1DM). A literature search identified a critical empirical gap:no primary gamification trials specifically targeting or reporting disaggregated outcomes for emerging adults (ages 18–25) were identified in the reviewed literature base. Consequently, this review evaluates evidence from randomized controlled trials, observational studies, scoping reviews, and umbrella reviews across younger cohorts to analyze why child-centric gamification models fail to meet the transitional needs of adolescents and young adults (AYA). The analysis focuses on digital elements, theoretical grounding, and longitudinal retention. Results indicate that gamified interventions enhance initial user engagement and short-term behavioral modifications, notably increasing self-monitored blood glucose frequency. While interventions yield positive psychosocial responses, changes in glycated hemoglobin (HbA1c) rarely achieve clinically durable normalization. Longitudinal evaluations consistently demonstrate a novelty effect, wherein engagement declines as manual data-entry burdens outweigh extrinsic rewards, driving high attrition. Although gamified mHealth applications provide psychosocial support and facilitate disease management, current evidence does not support their use as standalone tools for glycemic normalization. Sustained clinical efficacy requires shifting focus from extrinsic rewards toward comprehensive behavioral frameworks. Theoretical alignment with models such as Self-Determination Theory is insufficient unless paired with strong usability, age-appropriate design, seamless hardware integration, and structured clinical care.