Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 6, 2023
Date Accepted: Oct 30, 2024
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Effect of Multimodal App-based Interventions on Glycemic Control in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis
ABSTRACT
Background:
Digital technologies for Type 2 Diabetes (T2DM) care hold great potential to improve the patients health in the long term. A subset of telemedicine offerings are app-based interventions (AB-I) that operate primarily stand-alone. Currently available evidence is mainly focused on a broad range of (telemedicine) interventions or addresses multiple diseases. This does not allow conclusions about the efficacy of primarily stand-alone app-based interventions (SAB-I) addressing patients with T2DM.
Objective:
The objective of this systematic review is to analyze the efficacy of multimodal primarily SAB-I in patients with T2DM and to elicit the potential of such. The outcome of interest is a reduction in the long-term blood glucose (HbA1c).
Methods:
A systematic literature search was conducted in the literature bases PubMed, LIVIVO and Cochrane, based on the predefined PICO-scheme. To extensively collect available evidence, systematic reviews and RCTs as well as non-RCTs were eligible. Identified studies were assessed regarding risk of bias (RoB 2, ROBINS-I) and pragmatism (PRECIS-2). Overall quality of evidence was assessed using the GRADE tool. Meta analyses were conducted for between-group differences, using RCTs only, and for within-group differences, using RCTs and non-RCTs, to examine the effect of the interventions on HbA1c. Subgroup analyses were performed regarding the involvement of health care professionals and diabetes-specificity of the apps.
Results:
In total, 795 records were identified, of which 24 records were eligible for this systematic review and 23 studies were eligible for the meta analysis. Results of the meta analyses showed significant and clinically relevant reduction rates of HbA1c in patients with T2DM. Regarding the between-group difference for HbA1c reduction, the pooled effect of the RCTs showed a reduction of -0.36% [-0.59%, -0.14%; p < 0.001], favoring AB-I. The average mean within-group reduction in HbA1c is -0.79 [-1.02; -0.55], with no significant difference between RCTs (-0.69 [-1.13; -0.24]) and non RCTs (-0.87 [-1.16; -0.57]). The results of the rating of pragmatism showed that both study types are on average (very) pragmatic, i.e., close to usual care.
Conclusions:
This systematic review shows that primarily SAB-I can effectively improve the HbA1c- in patients with T2DM. The integration of digital health care into usual care holds great potential and should be considered as a complementary option to usual care in the future. The overall quality of evidence according to the GRADE assessment is rated as low to very low. However, besides known limitations, non-RCTs can be an important source to generate (real world) evidence. Clinical Trial: The systematic review was registered in the International prospective register of systematic reviews (PROSPERO; ID:CRD42023440203)
Citation
