The effectiveness of digital health technologies for patients with diabetes mellitus: A systematic review

Abstract

IntroductionDiabetes mellitus (DM) is a leading cause of morbidity and mortality worldwide. At the same time, digital health technologies (DHTs), which include mobile health apps (mHealth) have been rapidly gaining popularity in the self-management of chronic diseases, particularly following the COVID-19 pandemic. However, while a great variety of DM-specific mHealth apps exist on the market, the evidence supporting their clinical effectiveness is still limited.MethodsA systematic review was performed. A systematic search was conducted in a major electronic database to identify randomized controlled trials (RCTs) of mHealth interventions in DM published between June 2010 and June 2020. The studies were categorized by the type of DM and impact of DM-specific mHealth apps on the management of glycated haemoglobin (HbA1c) was analysed.ResultsIn total, 25 studies comprising 3,360 patients were included. The methodological quality of included trials was mixed. Overall, participants diagnosed with T1DM, T2DM and Prediabetes all demonstrated greater improvements in HbA1c as a result of using a DHT compared with those who experienced usual care. The analysis revealed an overall improvement in HbA1c compared with usual care, with a mean difference of –0.56% for T1DM, –0.90% for T2DM and –0.26% for Prediabetes.ConclusionDM-specific mHealth apps may reduce HbA1c levels in patients with T1DM, T2DM and Prediabetes. The review highlights a need for further research on the wider clinical effectiveness of diabetes-specific mHealth specifically within T1DM and Prediabetes. These should include measures which go beyond HbA1c, capturing outcomes including short-term glycemic variability or hypoglycemic events.

Development and Exploration of the Effectiveness and Feasibility of a Digital Intervention for Type 2 Diabetes Mellitus (DEsireD): Protocol for a Clinical Nonrandomized Pilot Trial in Brunei Darussalam

“…The majority of studies use the reduction of the HbA 1c level as a clinical marker for the effectiveness of digital interventions for patients with T2DM [ 16 , 30 ]. We agree with Stevens et al [ 16 ] that a wider measure of clinical effectiveness should go beyond HbA 1c .…”

“…The majority of studies use the reduction of the HbA 1c level as a clinical marker for the effectiveness of digital interventions for patients with T2DM [ 16 , 30 ]. We agree with Stevens et al [ 16 ] that a wider measure of clinical effectiveness should go beyond HbA 1c . Thus, this study will investigate changes in fasting blood glucose, lipid profile, and health-related QOL (measured by the assessment of the EQ-5D-5L [ 31 , 32 ]).…”

“…Finally, in the absence of comparison, the reference end point of a 0.6 reduction in HbA 1c over 16 weeks was used as a benchmark for clinical effectiveness. Our rationales include the effect of other mobile health interventions on the reduction of HbA 1c levels are between a WMD of 0.40 to a mean average of 0.9 [ 15 , 16 ] and the effect of oral diabetic medication as monotherapy is expected to reduce HbA 1c by 0.5 to 2.0 [ 33 ]. Thus, a lower average number of 0.6 was used.…”

“…This includes a diabetes digital intervention. Globally, there are multiple studies demonstrating the effectiveness of digital interventions [12][13][14][15][16][17]28,29], but there are limited studies conducted in Southeast Asia, particularly in Muslim-dominant populations [16]. This study will be useful for health care professionals and policy makers to understand the possible barriers to the implementation process during the subsequent phases of rolling out an app for T2DM management as a nationwide digital health solution in Brunei [19].…”

“…Results from two 2020 systematic reviews and meta-analyses have shown that mobile health interventions (eg, mobile phone SMS text messages, smartphone apps, wearables, portable monitoring devices, or web-based coaching) can significantly improve hemoglobin A 1c (HbA 1c ) with a standardized mean difference of –0.44 [ 14 ] and a weighted mean difference (WMD) of –0.4 when compared with traditional treatment and a fasting blood glucose WMD of –0.52 [ 15 ]. A more recent systematic review in 2022 has also revealed an overall improvement in HbA 1c (–0.9%) compared with usual care for T2DM [ 16 ]. Digital interventions have also been used to reduce BMI and waist circumference by 1.7 kg/m 2 and 5.77 cm, respectively [ 17 ].…”