JMIR Publications

ABSTRACT

Background:

Various mobile technologies and digital health interventions (DHIs) have been developed for type 2 diabetes management. Strategies are crucial for the effectiveness of DHIs. However, there is currently a lack of categorization and summary of the strategies used in DHIs of type 2 diabetes mellitus (T2DM).

Objective:

This study aims to (1) identify and categorize the strategies used in DHIs on type 2 diabetes management; (2) assess the effectiveness of these DHI strategies; (3) compare and rank the efficacy of different strategy combinations on glycated hemoglobin A1c (HbA1c), fasting blood glucose (FBG), body mass index (BMI), and weight loss.

Methods:

Relevant randomized controlled trials (RCTs) were extracted from PubMed, Web of Science, and Scopus databases. Three rounds of screening and selection were conducted. The strategies were identified and categorized based on the principles of Behavior Change Techniques (BCTs) and Behavior Strategies (BSs). The synthesis framework for the assessment of health information technology (SF/HIT) was used to structure the evaluation of the DHI strategies qualitatively. A network meta-analysis was performed to compare the efficacy of different strategy combinations. The data quality was assessed using the Cochrane Risk of Bias tool. This study was registered in PROSPERO, number CRD42024544629.

Results:

A total of 52 RCTs were included, identifying 63 strategies categorized into 19 strategy themes. The most commonly used strategies were guide, monitor, management, and engagement. Most studies reported positive or mixed outcomes for most indicators based on the SF/HIT. Research involving a medium or high quantity of strategies was found to be more effective than research involving a low quantity of strategies. 27 RCTs were included in the network-meta analysis. The strategy combination composed of communication, engagement, guide, and management was most effective in reducing HbA1c, while the strategy combination that included guide, management, and monitor was effective in reducing FBG. Strategy combination composed of communication, engagement, goal setting, management, and support was most effective for BMI and weight management.

Conclusions:

Several DHI strategy combinations have been effective in reducing HbA1c, FBG, BMI, and weight loss in type 2 diabetes management. Healthcare professionals should be encouraged to apply these promising strategy combinations in DHIs during clinical care. Future research should further explore and optimize the design and implementation of strategies.