JMIR Publications

ABSTRACT

Background:

Lifestyle interventions have been recognized as effective measures in the prevention of type 2 diabetes mellitus (T2DM). However, the accessibility of face-to-face interventions is often restricted. Digital health is proposed as potential solution to overcome the limitations inherent in face-to-face interventions. Nevertheless, there remains a significant gap of the effectiveness of digital health interventions on individuals with prediabetes, particularly in reducing T2DM incidence and reverting to normoglycemia.

Objective:

This study aimed to assess the effectiveness of digital health interventions, in conjunction with face-to-face lifestyle intervention, in preventing the progression to T2DM and facilitating the reversion to normoglycemia in adults with prediabetes.

Methods:

A comprehensive search was conducted across nine electronic databases, namely MEDLINE, Embase, ACP Journal Club, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Clinical Answers, Cochrane Methodology Register, Health Technology Assessment, and NHS Economic Evaluation Database via Ovid, from inception to 31st May 2022. This review included randomized controlled trials (RCTs) that examined the effectiveness of lifestyle interventions in adults with prediabetes. The relative effects were synthesized using a random-effects model. The I² statistic was employed to assess statistical heterogeneity between RCTs. A subgroup analysis was conducted to assess the comparative relative effectiveness of digital health, face-to-face, and their combined interventions. The Cochrane Risk of Bias 2 tool was employed to evaluate the risk of bias.

Results:

54 articles encompassing 31 studies were included in this meta-analysis from 7 384 articles retrieved initially. The findings revealed that digital health interventions, when compared to usual care, were associated with a 12% reduction in the incidence of T2DM (RR=0.88, 95%CI: 0.77-1.01, I2=0.6%, P=.41). However, these interventions did not significantly impact the reversion to normoglycemia. In contrast, face-to-face lifestyle interventions demonstrated a significant 45% reduction in T2DM incidence (RR=0.55, 95% CI: 0.48-0.63, I²=41%, P=.02), and a 44% improvement in the reversion to normoglycemia (RR=1.44, 95% CI: 1.15-1.81, I²=84%, P<.001), when juxtaposed with usual care. Moreover, an integration of face-to-face and digital health interventions suggested a 38% reduction in T2DM incidence (RR=0.62, 95% CI:0.44-0.88, I2=0%, P=.57). However, the effectiveness on reversion of digital health intervention and the integration of two interventions was not observed.

Conclusions:

The face-to-face interventions have consistently showed promising results in both reduction in T2DM incidence and reversion to normoglycemia in adults with prediabetes. However, the exclusive use of digital health interventions and the integration of face-to-face and digital health interventions has not yet been adequately substantiated reduction in T2DM incidence and reversion, primarily due to the limited number of studies available. Given these findings, there is a pressing need for more research to provide definitive evidence and subsequently maximize the effectiveness of the interventions to the prediabetes in the future. Clinical Trial: PROSPERO CRD42023414313; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=414313