JMIR Publications

ABSTRACT

Background:

Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires a multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate healthcare services. The emergence of telehealth services has provided the public with various tools for educating themselves, and for evaluating, monitoring, and improving their health- and nutrition-related behaviours. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences.

Objective:

The primary objective of this scoping review was to identify the key digital-tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined.

Methods:

A 5-step scoping review methodology following Arksey and O'Malley's methodology was used to map relevant literature published between January 2010 and March 2022. Electronic searches were performed in Medline, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention that combined self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles to be reviewed and extracted the data. PRISMA-ScR guidelines have been followed.

Results:

This review synthesizes the results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least one health professional. The health professionals participating in these studies were physicians, dietitians, nurses, and psychologists. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices (for example, a Bluetooth-connected blood glucose meter). We classified the features of these technologies into eight categories, depending on the intervention objective: 1- Glycemic monitoring, 2- Physical activity monitoring, 3- Medication monitoring, 4- Diet monitoring, 5- Therapeutic education, 6- Health professional support, 7- Other health data monitoring, and 8- Healthcare management. The patient-logged data revealed behaviour patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management and therapeutic education, translate into better glycemic control and the adoption of healthier lifestyles. Likewise, they appear to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise, automatically generated reports.

Conclusions:

This scoping review synthesizes multiple studies that describe the development and evaluation of complex telehealth interventions used in combination with a healthcare professional’s support. It suggests that combining different digital tools that incorporate diabetes self-management and monitoring features with a health professional’s advice and interaction results in more effective interventions and outcomes.