JMIR Publications

ABSTRACT

Background:

The proliferation of digital technology has the potential to transform diabetes management. One of the critical aspects of modern diabetes management remains the achievement of glycemic targets to avoid acute and long-term complications.

Objective:

We aimed to describe the landscape of evidence pertaining to the relative effectiveness/efficacy and safety of various digital interventions for the self-management of type 2 diabetes mellitus (T2DM), with a primary focus on reducing glycated hemoglobin A1c (HbA1c) levels.

Methods:

A systematic literature review (SLR) was conducted by searching Embase, MEDLINE®, and CENTRAL on April 5, 2022. Study selection, data extraction, and quality assessment were performed by two independent reviewers. The primary meta-analysis was restricted to studies that reported lab measured HbA1c. In secondary analyses, meta-regression was performed with intensity of coaching in the digital intervention as a categorical covariate.

Results:

In total 28 studies were included in this analysis. Most studies (82%) used the reduction of HbA1c levels as primary endpoint, either directly or as a part of a multi-component outcome. Twenty-one studies reported statistically significant results with this primary endpoint. When stratified into three intervention categories by the intensity of the intervention supporting the digital health technology, (analyzing all 28 studies) the success rate appeared to be proportional to the coaching intensity (i.e., higher-intensity studies reported higher success rates). When the analysis was restricted to randomized controlled trials (RCTs) using the comparative improvement of HbA1c levels, the effectiveness of the interventions was less clear. Only half of the included RCTs reported statistically significant results. The meta-analyses were broadly aligned with the results of the SLR. The primary analysis estimated greater reduction in HbA1c associated with digital interventions compared to usual care (-0.31%; 0.95% confidence interval [CI]: -0.45, -0.16; P<.0001). Meta-regression estimated reductions of -0.45% (95% CI: -0.81, -0.09; P<.02); -0.29% (95% CI: -0.48, -0.11; P<.003); and -0.28% (95% CI: -0.65, 0.09; P<.2) associated with high, medium, and low intensity interventions, respectively.

Conclusions:

These findings suggest that reducing HbA1c levels in individuals with T2DM with the help of digital interventions is feasible, effective, and acceptable. One common feature of effective digital health interventions was the availability of timely and responsive personalized coaching by a dedicated healthcare professional.