Improving Glycemic Control in Type 2 Diabetes Using Mobile Applications and e-Coaching: A Mixed Treatment Comparison Network Meta-Analysis

Abstract

Objectives: This study compared the effectiveness of glycemic control among usual care, care management using a mobile application (app), and management using an app with additional e-coaching for patients with type 2 diabetes mellitus (T2DM) using a mixed treatment comparison (MTC) network meta-analysis (NMA). Methods: A systematic search for published randomized controlled trials (RCTs) was conducted, which included Pubmed, Web of Science, Cochrane Central Register of Controlled Trials, CINAL, Koreamed, KMbase, and ScienceOn, until October 2020. Among the 10,391 studies identified after removing duplicates, 14 RCTs were finally included in the MTC NMA. Data extraction and methodological quality assessment using version 2 of the Cochrane tool for assessing the risk-of-bias in randomized trials (RoB 2) was performed. The comparative efficacy was analyzed using the random-effects NMA based on a frequentist model by the intervention group and main outcome variables. Results: At the 3-month follow-up after each intervention, a comparison of the P-scores revealed the app plus e-coaching intervention to be the most effective method for reducing the HbA1c level in a homogeneous gender ratio group (P-score 0.92). At the 6-month follow-up period, app intervention was the best in reducing the HbA1c level in the homogeneous gender ratio and under 60 years of age group (P-score 1.00). Conclusions: Based on MTC analysis using the data from published RCTs, mobile apps or apps with e-coaching interventions for T2DM patients were more effective in improving the HbA1c values, FBS, and hypoglycemia frequency than usual care. Nevertheless, further research will be needed to clarify the effects of adding e-coaching to the app. Study registration: Research Registry UIN (reviewregistry780)

Efficacy of Personalized Diabetes Self-care Using an Electronic Medical Record–Integrated Mobile App in Patients With Type 2 Diabetes: 6-Month Randomized Controlled Trial

“…However, the effect of apps on mHealth interventions remains inconclusive and unclear because of heterogeneous interventions and various lengths of follow-up. On the basis of a mixed treatment comparison network meta-analysis using data from published randomized controlled trials (RCTs), mobile apps or apps with e-coaching interventions for patients with T2DM were more effective in improving the hemoglobin A 1c (HbA 1c ) levels, fasting glucose, and hypoglycemia frequency than usual care (UC) during a 3- or 6-month follow-up period [ 7 ]. A meta-analysis of 13 studies on mobile apps for diabetes suggested overall efficacy in reducing HbA 1c levels, with a mean decrease of 0.44% (95% CI 0.29%-0.59%), as well as increased perception of self-care among mobile app users [ 8 ].…”

An umbrella review of effectiveness and efficacy trials for app-based health interventions

“…All reviews searched at least two databases and provided their full search strategy in the final report, but 25 reviews 16 , 17 , 19 , 21 , 22 , 27 – 29 , 33 , 38 , 39 , 41 , 43 , 45 , 47 – 50 , 52 – 55 , 58 , 59 , 61 failed to justify publication restrictions, for example regarding language, entailing a “no” on item 4. Six reviews provided a list of studies excluded at full-text screening stage (item 7) 26 , 37 , 42 , 48 , 56 , 57 . Overall, a satisfactory assessment tool for risk of bias was used (item 9).…”

“…4 . Most reviews targeted specific indications, including type 2 diabetes (T2DM) ( n = 5) 19 , 20 , 22 , 23 , 26 , hypertension ( n = 4) 15 , 27 , 31 , 38 , depression ( n = 3) 33 , 53 , 61 , overweight/obesity ( n = 3) 40 , 41 , 52 , chronic obstructive pulmonary disease (COPD) ( n = 2) 35 , 39 , urinary incontinence ( n = 2) 56 , 62 , asthma ( n = 1) 57 , autism spectrum disorders ( n = 1) 32 , post-traumatic stress disorder (PTSD) ( n = 1) 59 , type 1 diabetes ( n = 1) 47 , Parkinson’s disease ( n = 1) 45 , knee arthroplasty ( n = 1) 46 and lower back pain ( n = 1) 51 . Twenty-two reviews covered multiple conditions within their scope, such as diabetes of various types ( n = 7) 18 , 21 , 24 , 25 , 36 , 37 , 50 , chronic non-communicable diseases ( n = 2) 55 , 58 , anxiety and depression ( n = 2) 43 , 49 , conditions requiring rehabilitation ( n = 2) 42 , 44 , pediatric diseases ( n = 1) 54 , diseases requiring medication ( n = 2) 17 , 34 , cardiovascular diseases ( n = 2) 16 , 30 , pain conditions ( n = 2) 48 , 60 , mental illnesses ( n = 1) 28 , or a combination of diabetes and hypertension ( n = 1) 29 ...…”

“…Eleven reviews reported results on T2DM patients. Five focused on T2DM alone 19 , 20 , 22 , 23 , 26 , while six included broader populations but conducted (subgroup) analyses specifically on T2DM 21 , 24 , 25 , 36 , 37 , 58 . All eleven reviews except one 19 assessed glycemic control, operationalized as change in glycated hemoglobin (HbA1c) reduction, as main or secondary outcome.…”

Type 2 Diabetes Management Intervention Using a blended in-person and Mobile Application: A Feasibility Study

“…In contrast, a blended intervention can retain the positive aspects associated with both forms of therapy while mitigating the disadvantages. A recent meta-analysis suggests that blended mobile interventions with e-coaching have been shown to be effective in managing T2DM (17). Specifically, when compared to the standard of care, mobile application use with a care team was associated with reductions in HbA1C, fasting blood glucose, and incidents of hypoglycemia (17).…”