Previously submitted to: JMIR mHealth and uHealth (no longer under consideration since Aug 13, 2025)
Date Submitted: Dec 18, 2024
Warning: This is an author submission that is not peer-reviewed or edited.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.
Technological functionality and system architecture of mobile health interventions for diabetes management: A systematic review and meta-analysis of randomized controlled trials
ABSTRACT
Background:
With the advancement of digital health technologies, mobile Applications (Apps) have garnered significant attention for their role in diabetes management. However, there is still a lack of recent systematic evaluations of their overall effects and outcomes in this field.
Objective:
This meta-analysis aims to systematically evaluate the overall effectiveness of mobile Applications in diabetes management.
Methods:
Searches were conducted on PUBMED, EMBASE, COCHRANE, SCOPUS and WEB OF SCIENCE from inception to August 2024. Randomized controlled trials (RCT) investigating the effectiveness of App-based interventions in health management among diabetic patients were included. Reviewers were paired and independently conducted the screening of studies, data extraction and evaluation of study quality. The primary outcome of interest was the modification of hemoglobin A1c (HbA1c). A random effects model was utilized to calculate the weighted mean differences (WMDs) and 95% confidence intervals (CIs), and the I2 statistic was used to gauge study heterogeneity. The Publication bias of the primary outcomes was assessed. Studies were Appraised for quality using the Cochrane Risk of Bias assessment.
Results:
41 studies of 3911 initially identified articles that met the selection criteria. The results showed that Apps' intervention significantly improved glycemic control in diabetic patients, with a mean reduction in HbA1c levels of 0.49% (95%CI: -0.65 to -0.32%) compared to standard care. The analysis also revealed that Apps enhanced patient self-management behaviours. Subgroup analyses did not resolve heterogeneity, but improvement in HbA1c levels has been consistently observed. The quality assessment results indicated that most studies performed well in the completeness of outcome data and selective reporting.
Conclusions:
This meta-analysis confirms that mobile health applications with effective technological functionalities and system architectures are beneficial in managing diabetes. These applications significantly reduced HbA1c levels and improved self-management behaviors. Although some studies exhibited a moderate risk of bias, the overall evidence supports the use of these applications as valuable tools in diabetes care. Future research should standardize application features, refine system architectures, and address bias issues to further enhance their effectiveness. Clinical Trial: CRD42023441365
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