JMIR Publications

ABSTRACT

Background:

Culturally and linguistically diverse populations are at a higher risk of developing prediabetes; however, the effectiveness and implementation of digital health interventions for prediabetes management in this population are not well understood.

Objective:

This review aims to evaluate the effectiveness and implementation of digital health interventions (DHIs) versus usual care for glycemic control in culturally and linguistically diverse populations living with prediabetes.

Methods:

This review included people of any age living with prediabetes who are from a culturally and linguistically diverse background. Experimental and quasi-experimental studies that compare digital health interventions to usual care, waitlist, or active control were eligible. The primary outcome was glycemic control as measured by HbA1c. A comprehensive search was conducted in CINAHL, Cochrane Library, Embase, MEDLINE, three trial registers, and grey literature databases, along with reference lists for additional studies. Studies published in English and published since the inception of each database were included. Statistical analyses included meta-analysis, sensitivity analyses, subgroup analyses, meta-regression, and publication bias assessments. The methodological quality was assessed using the JBI critical appraisal tools, and the quality of evidence was evaluated using GRADE to create Summary of Findings tables. Random-effects models with restricted maximum likelihood estimation were employed.

Results:

From 14 included studies with 5,714 participants, the meta-analysis showed DHIs led to a reduction in HbA1c (P < .01); however, evidence certainty was low (MD = -0.14, 95% CI [-0.24, -0.05]). Effects on fasting blood glucose (FBG) and body weight remain uncertain. Implementation outcomes demonstrated high uptake (>78.8%), engagement (>80%), and intention rates (89.1%) among culturally and linguistically diverse populations with prediabetes. Significant heterogeneity was observed in both RCTs and pre-post studies. Subgroup analyses revealed reduced heterogeneity in 12-month interventions (I² = 0.00%) and waitlist controls (I² = 0.01%). Meta-regression identified comorbidity status as the only significant contributor to heterogeneity (P < .05). Sensitivity analyses demonstrated robust significant effects (P < .01). Publication bias assessment showed mixed results (Begg’s P = .232, Egger’s P < .1), but trim-and-fill analysis confirmed the robustness of findings with no missing studies.

Conclusions:

The evidence suggests that DHIs demonstrate potential for improving glycemic control in culturally and linguistically diverse populations living with prediabetes, but the certainty of evidence is low. The observed heterogeneity could be attributed to intervention duration, control type, and participants’ comorbidity status. While the findings related to implementation were encouraging, further rigorous research considering contextual, individual, and cultural factors is needed. Clinical Trial: This review was registered with PROSPERO (CRD42024556292).