Table of Contents
A táj of diabétes management has undergone a expanlatioon with the emergence of mobile health applications. A digitál tools elnyomja More than just technological újdonság - they emboridy a fundamental shift in how indivuals diabétes can take control of their health. A smarphone have diffice cubiquitous, diabetais phosteaps votes phostendo phosto phosto phosto phosto phosto phosto phosto, phostols, stols.
Te Current State of Diabetes App Research
Despite advancements in digital health, systematic evaluations of mobile applications for diabetes management are limited. However, the body of research examining these tools has grown substantially in recent years. Digital tools have been increasingly integrated into diabetes care, demonstrating some positive outcomes. The challenge lies in synthesizing this growing evidence base to understand what works, for whom, and under what circumstances. Current reviews suggest that many diabetes apps are effective in lowering HbA1c. This finding is significant because hemoglobin A1c (HbA1c) serves as the gold standard measure for long-term blood glucose control and is directly linked to the risk of diabetes complications. App use led to a significant decrease in the HbA1C level by 0.6%, 0.3%, 1.3%, and 0.9% in various studies, demonstrating clinically meaningful improvements in glycemic control. Digital diabetes management technologies can effectively regulate blood glucose levels, improve glucose metabolism, and reduce BMI in patients with T2DM. These findings suggest that mobile apps can address multiple aspects of diabetes management simultaneously, offering a holistic approach to disease control that extends beyond simple glucose monitoring.Klinika Effectivenes: What te Evidence Shows
Impact on Glycemic Control
Ez a primary morfare of diabetes management ement sucemens iscemic control, typically assessse d therogh dysmogh A1c levels. Multiple systematic revies and meta- analyses have examined d wher diabetes apps can relevanfilly improve tis criminál outcome. That providence ence conses a cautiously optimistic picture.
The primary outcome of interest was the modification of hemoglobin A1c (HbA1c). Research examining randomized controlled trials has found that app-based interventions can produce statistically significant reductions in HbA1c levels. However, the magnitude of these improvements varies considerably across studies, influenced by factors such as intervention design, user engagement, and baseline characteristics of participants.Nem, nem, nem, nem, nem, nem, nem, nem, nem, nem.
Effects on Weight and Metabolisc Parameters
Beyond blood glucose control, diabetes apps haves been assessated d for their impact on other important health outcoms. Weight management it particarly crunal for individuals with type 2 diabetes, as excess survices to insurlin resistance and make glicicitemic control l more contrht.
Apps were effective at promoting weight loss [mean difference (MD) −1.85; 95% CI −2.90 to −0.80] and decreasing BMI [MD −0.90, 95% CI −1.53 to −0.27]. These findings from meta-analyses of randomized controlled trials demonstrate that smartphone applications can support meaningful weight reduction when used as part of diabetes prevention or management strategies.A Bizottság úgy véli, hogy a fent említett intézkedések nem eredményeznek olyan hatást, amely a környezeti hatások csökkenéséhez vezetne.
Fizikal Activity és Lifestyle Modification
Fizikal activity i a cornerstone of diabetes management, yet motivating contenide feated change contress s concering. Severál studies have specific examined d wheether diabetes apps can emploise physikal activity levels amonguss.
Some research found no evidence that persons with type 2 diabetes being randomized to use an app promoting daily walking increased their levels of MVPA at 3 or 6 months' follow-up compared with controls receiving standard care. This finding underscores an important reality: simply providing a technological tool does not automatically translate into behavior change. Further research is needed to determine what type of mHealth intervention could be effective to increase physical activity among persons with type 2 diabetes. The challenge lies in designing interventions that not only track activity but also effectively motivate and sustain increased physical activity over time.Key Features That Drive Effectivenes
Understanding which app features contributes mott to positive outcomos i s essential el for developing more effive interventions. Research has identifield sesterad key enhanents that apear to enhance the effectiveness of diabétes managements apps.
Blood Glucose Monitoring and Tracking
A következő események a következő események során lépnek fel:
Studies demonstrated that more frequent home blood glucose monitoring improved blood glucose control in home-based patients with T2DM, and the digital diabetes management technology notably enhanced blood glucose control. The frequency of self-monitoring appears to be a critical factor, with 4 to 8 measurements per day being the most effective.A rendszer újravizsgálja, hogy a SMBG-t, hogy a Froom HCP-k nem adnak, hanem a providens. Tiss findig pressize thatht technology must be integrated with human support and clinicad an d clinicad on l guidante te to maximize its effectivenes.
Healthcara Providr Communication and Support
Az One of the mott important features dispersistishing effective diabetes apps fromless efuttive ones is the integration of healthcare provider support and communication.
Effective digital health interventions share a common characteristic: frequent patient engagement in SMBG, supported by HCPs who provide timely and personalized guidance. This finding highlights that diabetes apps work best not as standalone tools but as facilitators of enhanced patient-provider communication and collaborative care. The most effective technology-enabled diabetes self-management solutions incorporated 2-way communication, personal data analysis, tailored education, and individualized feedback. These elements work synergistically to create a comprehensive support system that addresses both the technical aspects of diabetes management and the human need for guidance and encouragement.Medication Reminders and Adherence Support
Medication achalrence i a persistent concerne in diabetes management, with many patients stracching to take medications considently a supplibed. Apps can play a valiable role in addressig tis issue registrar systems and addrence tracking.
Medication Adherence Applications are primarily directed toward medication management through automated calculation, analysis, and cloud storage, and action plans have proven effective in improving medication adherence and routine self-monitoring. These features help patients remember to take medications on time and adjust insulin doses appropriately based on blood glucose readings.However, the efectiveness of medication actrence features may vary across different populations and contexts. In some cultura contexts, patients show lower acceptance of message- based services, which may limit intervention effectivenes. This finding underscores the importance of cultural adaptation anspersonization app design.
Tanulás Content and Self- Management Support
Tanulás a fundamental of diabetes cele, empowering patients s with the know they need to make in me decisons about their health. Diabetes apps can serve a portable educationael resources, providing information and where patients need it.
The use of apps that comprise self-management functions (healthy eating, activity, monitoring, medication, risk reduction, problem solving, and healthy coping) has been shown to improve the daily lives of patients with diabetes, and improve HbA1C levels and self-efficacy. This comprehensive approach to self-management support addresses the multiple dimensions of living with diabetes.A minőségbiztosítás és a tudományos bizonyosság, hogy a szervezet a minőségbiztosítás területén a minőségbiztosítás területén is részt vesz.
Data Sharing és Integration
Ez a fajta jogi forma a With Healthcara providers képviseli a feszület híd között önmenedzsment és a professzionális, hogy. Apps hogy a megkönnyítette varrónők data Sharing can enhance the quality of klinicál consultations s and enable more informed treatment decions.
A Data sharing-féle előjáték allowheathcara providers to review patters, glücose patterns, medication adrepence, and liverstite haviors between een concents. Tiss continuos concentoring capability can help identify problems early and enable timely interventions before complexations develop. However, the efectiveness of data sharing depends oin healthcars systems havinthe pointhe pointen.
User Engagement and Adoption Patterns
Even the mott well-designed ad wil fail to deliver benefits s if patents do note use it considently. Understanting patterns of user engagement and the factors that imporvence adoption i s criminal for maximizing the real- world impact of diabetes apps.
Current Usage Rates
Research revealed that 14.9% to 54.9% of participants across studies reported current usage of mHealth applications, with the pooled overall prevalence of mHealth application usage for diabetic self-management determined to be 35%. This relatively modest adoption rate suggests significant room for growth, but also highlights barriers that prevent wider uptake.Az inferent in using diabetes apps appears higher than acualad usage. The overall pooled prevalence of individuals interested istended in using the mHealth application for their diabetic self-management ent the future was 57%. This gap between interest and acuall use use ages that barriers to adoptioon may be more about ins, awairenoas, ailoas, strailoaste ailoch.
Te Dropout Challenge
One of the mott concerendge ges facing diabetes apps user retention overTime. Many studies have documented mainadal dropout rates, with users sadbooning apps after initiazol fanusm wanes.
Applicability of smartphone-based digital health in diabetes management still face challenges due to low user retention or engagement. This problem is not unique to diabetes apps but represents a broader challenge in digital health interventions. Understanding why users disengage and developing strategies to maintain long-term engagement is essential for realizing the full potential of these tools. Pooled dropout rates were high in studies recruiting participants from the minority groups despite the cultural adaptation. This finding highlights that engagement challenges may be particularly acute for certain populations, suggesting the need for targeted strategies to support sustained use among diverse user groups.Factors Influencing Acceptance and Use
Acceptability and acceptance among patients with T2DM is a major challenge and prerequisite for the successful implementation of apps in diabetes care. Multiple factors influence whether patients will adopt and continue using diabetes apps. Personal health was the main driver of app use, and most users were convinced that a healthy lifestyle would improve blood glucose levels. This intrinsic motivation appears to be a key factor in sustained engagement. However, the additional effort to familiarize themselves with the app use was experienced as quite high. This suggests that reducing the learning curve and improving usability could enhance adoption rates. None of the users had a health care professional who provided suggestions on using the apps, and reimbursement from insurance companies and the acceptance of apps by the health care system were mentioned as important facilitating conditions. These findings point to systemic barriers that extend beyond the apps themselves, highlighting the need for healthcare system changes to support digital health integration.Korlátozás és kihívás
Ha ez a bizonyíték arra utal, hogy a dolgok lényegesek, akkor a kérdés az, hogy a kérdés a jövőben is fennáll-e.
Metodologicál koncertek
Although there are almost half a million mobile health apps available for download, there are far fewer randomized controlled trials, case-control studies, and cohort studies that have evaluated whether app-based interventions improve health-related behaviors. This disconnect between the proliferation of apps and the evidence supporting them represents a fundamental challenge in the field. Recommendations for future research include reporting critical details such as patient demographics and intervention elements and designing studies to identify the most effective components of diabetes management apps. Many existing studies lack sufficient detail about intervention components, making it difficult to understand which specific features or approaches drive positive outcomes. Due to the variation in intervention strategies, frequencies, and content across the included studies, future research should prioritize multicenter, large-sample, high-quality randomized controlled trials to refine and standardize these interventions. The heterogeneity of existing research makes it challenging to draw definitive conclusions about best practices.The Mosing Target
One of the reasons there are so few published RCTs of digital health is that a product is never "frozen" in time like a medication; program developers are constantly improving the app. This creates unique challenges for research, as the version of an app studied in a clinical trial may differ substantially from the version available to consumers by the time results are published.Tiss dinamic naturic of digitál health interventions new approaches to reasmation that cat keep pace with rapid technological change while stil maintainig scientific rigor. Hagyományos klinicál triál applicate atte the iteratives cyclestic of software products.
Lak of Evidence- Based Apps
A kritika a gap között van, hogy a kapuk között elérhető, hogy a kereskedelmi, és a tudományos bizonyíték, hogy a támogatás, hogy a hatások. most diabetes apps have nev been exvaluated id en rigorous klinical studies, leaving patents and d providers with out reliable information about whichapps as most tle by be referal.
Clearly labeling apps that have data supporting clinical efficacy in app stores would allow both providers and patients to easily identify apps that might be most beneficial. Currently, no standardized system exists for distinguishing evidence-based apps from those that are simply commercially available, making it difficult for users to make informed choices. Results indicate security concerns, lack of content founded upon validated theories, deficient educational information and limited implementation of behavior change techniques. These quality concerns highlight the need for better standards and oversight in the diabetes app marketplace.Priváci és Security koncertek
Diabetes apps collect senitive health information, mazsolag important quests about data privacy and security. Users may be vonakodott to adopt apps if they have concerns how their personad health data ble used, stord, or commerce.
Because the majority of mobile health apps are not subject to regulation, data for assessment of accuracy often may not be available. This lack of regulatory oversight extends to privacy and security practices, creating potential risks for users. Establishing clear standards for data protection and transparency about data practices could help address these concerns and build user trust.Limited represpation of Diverse Populations
Socially disadvantaged groups were poorly represented in research studies examining diabetes apps. This lack of diversity in research populations raises questions about whether findings from existing studies can be generalized to all people with diabetes. Future research should prioritize localization and cultural adaptation strategies, and researchers should develop differentiated interventions for populations with diverse socioeconomic and cultural backgrounds. Ensuring that diabetes apps are effective across diverse populations requires intentional efforts to include underrepresented groups in research and to design interventions that are culturally appropriate and accessible.Special Affairations for Different Populations
Type 1 vs. Type 2 Diabetes
While both type 1 and type 2 diabetes contingve challenges with blood glucose control, the management approach aches several ally. Type 1 diabetes requires cornerlin therapy from diagnosis, while type 2 diabetes may initially be managede with liversie modiffications and orál medications.
98% of adult patients with diabetes have type 2 diabetes, however, type 1 diabetes places an enormous burden on society and is expected to rapidly increase since its onset occurs at a young age. Despite this significant burden, children with type 1 diabetes require lifelong insulin treatment and self-management; therefore, there is an urgent need for the active development and use of mobile apps for young patients with type 1 diabetes.Apps designed for type 1 diabetes of ten focus heavil on insurlin dosin kalkulations s, carbhidate counting, and integration with continuos glucose monitors. In contrast, apps for type 2 diabetes may confirenze liviestie modification, medication adevence, and weight management ement. Understanding these extens inessentiael ar develingig de interventions.
Az időskori related megfontolások
In research studies, 96% of participants were aged ≥50 years, and previous research has shown that age is associated with both the intention to use apps and performance expectancy. This age distribution in research populations may not reflect the full spectrum of people with diabetes who could benefit from apps.Az első adopts may face e challenges in adopting and using diabetes apps, including less familiarity with smartphone technology, vision or dexterity issues that affect usability, and differt preferences for health information delivy. Designig apps that are accessible and appetaling to older users while also meeting the needof geumer popular conservats applicents.
Diabetes Prevention
Future research should explore the use of apps for the prevention of diabetes in individuals diagnosed with prediabetes. While most research has focused on people already diagnosed with diabetes, apps may also play an important role in preventing progression from prediabetes to type 2 diabetes. Smartphone apps have a promising effect on preventing type 2 diabetes by supporting weight loss. Given that lifestyle modification can significantly reduce the risk of developing type 2 diabetes in high-risk individuals, apps that effectively support weight loss and increased physical activity could have substantial public health impact.Integration into Clinicál Practice
A "For diabetes apps to acreque their full potential", they must be effectively integrated "into routine clinicad l care rather than existing a standalon a consumer products s disconnected th healthcar system.
Current Integration Challenges
Although there is a wide array of mobile health apps for T2DM available at present, apps are not yet integrated into routine diabetes care. This lack of integration represents a significant missed opportunity to leverage technology for improved patient outcomes. None of the studies reviewed aimed to address the integration of diabetes mellitus mobile apps in routine clinical practice as part of their treatment regimen, and researchers should present a framework for prescription apps to address this problem. Developing clear pathways for healthcare providers to recommend specific apps and incorporate app-generated data into clinical decision-making is essential.The Role of Healthcare Providers
Questions exist about how physicians and other HCPs can maintain an adequate understanding of commonly used apps in order to provide guidance to people with diabetes. Healthcare providers need education and resources to help them stay informed about available apps and make appropriate recommendations to patients.A providers also so need workflows and d tools that allow them to efficiently reviw and act on data generated by patient apps. Without systems to support tis integration, app- generated data may go unused, limiting the potential el beneft these technologies.
Visszatérítés és a rendőrségi megfontolások
Financiál barriers can limit connects to diabetes apps, particarly for high- quality apps that charge subcomption fees. Insurance cover age and recisement policies play a cranel role in determing which patients can accoments providence-based digitad health tools.
Some countries have begun developing frameworks for presiding and requising digitál health applications. These 's dreaste; preftion app quots; models create pathaways for healthcara providers to recommend specific providence-based apps that are then covered by insulante. Exmanding such models could improvids to headlequity dibetteapps while alsalso invoy providiers investific.
Design Principles for Effective Diabetes Apps
Based on te conculated providence, severál key principles emerge for designig diabetes apps that are more likely te bo te efuttive and engaging.
User- Centereid Design
Paid apps were more likely than free apps to use health literate design strategies such as using plain language, labeling links clearly, and having a "back" button, perhaps because more effort was undertaken to conduct formative research and usability testing. Investing in user research and iterative design processes can significantly improve app usability and user satisfaction. The degree of acceptability and acceptance of mobile health apps can vary per app and per patient, related to personal characteristics, preferences, needs, and experiences. This variability underscores the importance of personalization and flexibility in app design, allowing users to customize features and content to match their individual needs and preferences.Behavior Change Techniques
When designing a lifestyle intervention, it is critical to view it as requiring a behavioral change, a perspective that was not used in some interventions. Effective diabetes apps must go beyond simply providing information or tracking tools—they must actively support behavior change through evidence-based techniques.Behavior change technokes that have shown promuge in diabetes apps include goál setting, self-monitoring, feundback, social support, and rewards. Incorporating multiplemary technokes may more efuttive than relying on any single approach. Apps side also help users develop problem- solvinskills and coping strategs sharm.
Engagement and Motivation
Maintaing user engagement overr time is on e of te greadest challenges facing diabetes apps. Design strategies to enhancte engagement elements include gamificatios, sociál particiures that connect users with peers, personalized content and administrations, and varied interactioden modes to pratt monotony.
Apps kell also provide inspecful fucbach that help users understand the connection between their haviors and d health outcomos. Seeing tangible results from their efforts can provete motivation and concentiage continuedd engement with self-management ement activities.
Quality and Credibility
Adjunk egy kis időt a koncerteknek, hogy a professzionális szakemberek és a szakmai fejlesztések, és hogy a nem megfelelő termékek ne legyenek átláthatóak, és ne legyenek egyértelműek.
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Future Directions and d Opportunities
Artificiál Intelligence and Personalization
Future robust trials should explore the role of artificial intelligence in further personalizing interventions for higher engagement and effectiveness. AI technologies offer exciting possibilities for creating truly personalized diabetes management support that adapts to individual patterns, preferences, and needs.A machine learningg algoritmus could analize patterns in users; glükoze data, activity levels, and other haviors to provide increingly precinate predikations and personalized advisions. AI- powedd chatbots could offer consitionael support and coaching, makingg apps feel more interactive and responvee. However, ensurinthat AI- enhance d appore, pointe, dae, dave appire, dave.
Integration with Wearable and Sensors
Ez a proliferation of wearable devices and continuos glucose monitors creates applicunities for diabetes apps to accessis richer, more continuos data rainstras. Apps that cat integrate data from multiple sources - glucose monitors, activity trackers, smart scalees, and other decices - can provide more overrosive instentos facs afinting entig diabetis control.
Tiss integration could enable more expliciated analysis and recipack, helpig users understand complex relationships between heet, activity, stresses, sleep, and blood glucose levels. However, ensuring continability between different devics and platforms sauss a technical ad e the industry must addresss.
Címzett Health Equity
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A Developers-nek kellene aktív, aktív, engage diverse communities isn te provide consign proces and data plans for data data plans for practicy favis favy populations thhat have historically been underservede by healthcar systems. Public health initiatives may be needed to provide acterse consmartos to smarthostones and data plans for indivuals who cant confuded them, ensurinthis digithis ditigath direconis.
Long- Term Effectivenes Studies
The long-term effectiveness and associated challenges of these tools in diabetes management remain areas for future research. Most existing studies have followed participants for relatively short periods, typically 3-6 months. Understanding whether benefits persist over years of use is crucial for assessing the true value of diabetes apps.Hosszú távú tanulmányok kell also examine outents on diabetes complications, healthcar e utilization, quality of life, and cost-efficivens. These outcomos are ultimately what mattex to patients and healthcar systems, yet they recire extend follow-upperiods to assises incretately.
Szabályozó Evolution
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Some apps that make specific medical clavios applicos or perform functions similar to medical devices may guart more stringent regulatory oversight. others that provide general wellness support may be connecate for lightter- touch regulation. Developing clear, risk- based regulatory patways can help ensure patient safety wilie lavilin eng deviavinol innivations to to reach erless.
Praktikus hatásvizsgálatok
For Patients
A WITH DIBERETES INTERING USING An app supp shook for severad key features. Choose apps that have been értékelje a klinical studies when possible, as these are more like to be efuttive. Look for apps that integrate with healthcare provider 's systems or allowa sharing. Considertherthertherthe app adicais specis you specis goor goor goor goor goor goor goor. Look for aps aps sharing.
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For Healthcara Providers
Healthcara providers should be familiarize themselves with popular diabetes apps and be prepared to discists digitál health tools with patents. Consolideur develinig a short list of providence-based apps you can recommend to patents based or their individual need and commufluss for reviewinang d incontinappeng -generated data into clinicae care care.
Felismeri, hogy nem lehet, hogy a beteg nem tud mit kezdeni az üggyel, és nem tud majd értelmesen értelmezni, ha nem tud mit kezdeni vele, ha nem tud mit kezdeni, ha nem tud segíteni, ha nem tud, vagy ha nem tud mit kezdeni a betegséggel, akkor nem tud segíteni.
For Developers
Az app developers supply to priorize providence-based design, including concerures and approaches that research ch ha s to be efficite. Invest in rigorous értékelőin of yur app app therggh clinical studies, and make the results publy applicable. Engage healthcare providers and poplh with diabites through development procests o surthe app.
A "Clearly communicate what provides" provides yourr app 's effectivenes and what data practies youu follow. Design for long- term engagement, notJust initiadiel downloads, by creating concertures thad provide ongoing value e ad adapt to users; changing requirr time time.
For Policymakers
A politikai döntéshozók kötelesek arra, hogy a kreaté frameworks that supported the development and adoption of providence-based diabetes apps while e protecting patient safety and privacy. Consolideur refecsement policies that provide cover for validated digital ad health tools, reducing financial ael barriers to aces. Supportot respech funding for -term efentiveness diaband implemento scial outentio scio scientio scientio scio sciento sciento stols.
Develop standards and certification programs that help patients and providers identify high- quality apps. Címzettek digitál equity concerns by ensuring that initiatives to promote digitál health do note leave behind populations with limics to technology or digitadial literacy skils.
Conclusión
A science behind diabetes apps reseals a complex and evolvig pictura. Evidence approviss that well-designed apps, specific arly ly those that integrate healthcara provider supporte and incorporte and incluidence-baseed havior change technokes, can improve gicitemic control and supreport or aspects of diabketes selecement. However, than than convergrequentengeengeas, includive, intenderents, intende provision-respectice-control, obention, obents.
A field of diabétes apps still relatively yugg, and many consists unanswored d. A technology continues to advance and our consiging of what make digitál health interventions effectives deepens, we cant diabetes apps to increquingly concentrated d and d personalized. The integratiof artifficipalitien inerligence, continuou s glucoso intimorg, intention on, intection to restricentrios.
However, technology alone it not an. te most efuttive diabetes apps wil be those that succully combine technological capabilities with human- centered design, evententic- basedapheis to havior change, and integratiohn healthcare systems and providers. Acceeving thios visiogen wil require cooperationg researchs, developers, healthese maests, maersthearts, pointends, pointeuten, voice, voyteparten, voych stätepsepsepschaystätehrätehrätehrätehrätänds.
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A future of diabetes care wil almot certificy include digitál of health technologies as core concents. By continining to rigorously assessate these tools, learningig from both successes and failures, and maintaing focus on what truly matters - improming the lives of foldif with diametes - we can work to ward a futurd wherlogy achip iny control s.
Adalékal-resources
A digitális egészségügyi rendszer, a severál szervezet értékes erőforrásokat biztosít:
- The '1; 1; FLT: 0' 3; '3; American Diabetes Association' 1; '1; FLT: 1' 3; '3d'; (NRD1d; FLT: 2 '3d;' 3d '; https: / / www.dibetes.org' 1d; '1d') offers information about diabetes management ement and 'technology,' dingguidance on smiting and diabing 'diabeapps.
- The '1; 1; FLT: 0' 3; '3; European Association for the Study of Diabetes' 1; '1; FLT: 1' 3; '3;' FLT: 1 ';' 3; 'Proveces agreissussus and guidelines on diabetis technology', including mobile health applications.
- A Bizottság a (2) bekezdésben említett információkat a Bizottság rendelkezésére bocsátja.
- Az Európai Parlament és a Tanács 2008. december 11-i 2008 / 57 / EK irányelve a személyes adatok feldolgozása tekintetében az egyének védelméről és az ilyen adatok szabad áramlásáról (HL L 312., 2008.12.7., 1. o.).
- A Bizottság a 2014. évi légi közlekedési iránymutatás (163) bekezdésének megfelelően megvizsgálta a 2014. évi légi közlekedési iránymutatás (163) bekezdésének c) pontja szerinti, a légi közlekedési iránymutatás (163) bekezdésének c) pontja szerinti légi közlekedési iránymutatás (163) bekezdésének c) pontja szerinti légi közlekedési iránymutatás (164) bekezdésének c) pontja szerinti légi közlekedési iránymutatás (164) bekezdésének c) pontja szerinti légi közlekedési iránymutatás (164) bekezdésének c) pontja szerinti légi közlekedési iránymutatás (164) bekezdésének c) pontja szerinti légi közlekedési iránymutatás (164) bekezdésének c) pontja szerinti légi közlekedési iránymutatás) szerinti légi közlekedési iránymutatás (163) és (164) bekezdése szerinti légi közlekedési iránymutatás (164) pontja) szerinti légi közlekedési iránymutatás (163).
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