Effectiveness of Digital Interventions for Improving Glycemic Control in Persons with Poorly Controlled Type 2 Diabetes: A Systematic Review, Meta-analysis, and Meta-regression Analysis

Kebede, Mihiretu; Zeeb, Hajo; Peters, Manuela; Heise, Thomas L; Pischke, Claudia R.

doi:10.1089/dia.2018.0216

Cited by 106 publications

(51 citation statements)

References 87 publications

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“…In face-to-face settings, structured education has been demonstrated to be effective for assisting people with T2DM to improve glycemic control and overall health [ 2 ]. Various authors suggest social support may increase participation [ 10 , 21 ]; however, this was not demonstrated in our results, as even the more complex web-based interventions offering contact with peers [ 31 , 32 ], and/or health care professionals [ 29 , 31 , 32 ] contributed no difference in terms of achieving clinical outcomes.…”

Section: Discussioncontrasting

confidence: 79%

“…Interventions using mobile apps show reductions in HbA 1c of 0.4%-1.9% [ 19 ], and the provision of telehealth has been associated with an average HbA 1c reduction of 0.17% [ 20 ]. In terms of the influence of intervention features on HbA 1c outcomes in people with T2DM, when compared to mHealth and telehealth interventions, statistically significant results were only found for web-based interventions, which may indicate that web-based interventions are particularly useful for eliciting behavior change in people with T2DM [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although people with T2DM need and want dietary education, web-based interventions to date have overwhelmingly focused on overall self-management [ 10 , 21 , 22 ]. While some interventions have included a healthy eating component within the intervention package, assessment of dietary adherence or behavior remains scarce.…”

Section: Introductionmentioning

confidence: 99%

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Web-Based Interventions for Dietary Behavior in Adults With Type 2 Diabetes: Systematic Review of Randomized Controlled Trials

Dening¹,

Islam²,

George³

et al. 2020

J Med Internet Res

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Background Type 2 diabetes mellitus (T2DM) is among the most prevalent noncommunicable health conditions worldwide, affecting over 500 million people globally. Diet is a key aspect of T2DM management with dietary modification shown to elicit clinically meaningful outcomes such as improved glycemic control, and reductions in weight and cardiovascular disease risk factors. Web-based interventions provide a potentially convenient and accessible method for delivering dietary education, but its effects on dietary behavior in people with T2DM are unknown. Objective The objective of this review was to determine the effectiveness of web-based interventions on dietary behavior change and glycemic control in people with T2DM. Methods Per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, systematic literature searches were performed using Medline, Embase, The Cochrane Library, and CINAHL to retrieve papers from January 2013 to May 2019. Randomized controlled trials of web-based interventions in adults with T2DM with reported dietary assessment were included. Population and intervention characteristics, dietary guidelines and assessments, and significant clinical outcomes were extracted. Differences between groups and within groups were assessed for dietary behavior and clinical outcomes. Results There were 714 records screened, and five studies comprising 1056 adults were included. Studies measured dietary changes by assessing overall diet quality, changes in specific dietary components, or dietary knowledge scores. Significant improvements in dietary behavior were reported in four out of the five studies, representing healthier food choices, improvements in eating habits, reductions in carbohydrates, added sugar, sodium, saturated fat and overall fat intake, and/or increases in dietary knowledge. Three studies found significant mean reductions for hemoglobin A1c ranging from –0.3% to –0.8%, and/or weight ranging from –2.3 kg to –12.7 kg, fasting blood glucose (–1 mmol/L), waist circumference (–1 cm), and triglycerides (–60.1 mg/dL). These studies provided varied dietary recommendations from standard dietary guidelines, national health program guidelines, and a very low carbohydrate ketogenic diet. Conclusions This review provided evidence that web-based interventions may be an effective way to support dietary behavior change in people with T2DM, potentially leading to changes in glycemic control and other clinical outcomes. However, the evidence should be viewed as preliminary as there were only five studies included with considerable heterogeneity in terms of the diets recommended, the dietary assessment measures used, the complexity of the interventions, and the modes and methods of delivery.

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Section: Discussioncontrasting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Web-Based Interventions for Dietary Behavior in Adults With Type 2 Diabetes: Systematic Review of Randomized Controlled Trials

Dening¹,

Islam²,

George³

et al. 2020

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…It serves as a medium for propagating messages with regards understanding the features, risk factors and complications of diabetes [ 17 ]. Mobile phones (especially smartphone) have gained popularity in diabetes prevention and follow-up intervention programs in developed countries, where they are being used to implement actions to promote a healthy diet, regular physical activity and to prevent obesity, enhance the engagement of patients to diabetic care as well as to reduce the number of care drop outs and improve glycaemic control [ 18 - 22 ].…”

Section: Introductionmentioning

confidence: 99%

Mobile phone ownership and willingness to receive mHealth services among patients with diabetes mellitus in South-West, Nigeria

Olamoyegun¹,

Raimi²,

Ala³

et al. 2020

Pan Afr Med J

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Introduction mobile phone technology is increasingly used to overcome traditional barriers to limiting access to diabetes care. This study evaluated mobile phone ownership and willingness to receive and pay for mobile phone-based diabetic services among people with diabetes in South-West, Nigeria. Methods two hundred and fifty nine patients with diabetes were consecutively recruited from three tertiary health institutions in South-West, Nigeria. Questionnaire was used to evaluate mobile phone ownership, willingness to receive and pay for mobile phone-based diabetic health care services via voice call and text messaging. Results 97.3% owned a mobile phone, with 38.9% and 61.1% owning smartphone and basic phone respectively. Males were significantly more willing to receive mobile-phone-based health services than females (81.1% vs 68.1%, p=0.025), likewise married compared to unmarried [77.4% vs 57.1%, p=0.036]. Voice calls (41.3%) and text messages (32.4%), were the most preferred modes of receiving diabetes-related health education with social media (3.1%) and email (1.5%) least. Almost three-quarter of participants (72.6%) who owned mobile phone, were willing to receive mobile phone-based diabetes health services. The educational status of patients (adjusted OR [AOR]: 1.7{95% CI: 1.6 to 2.1}), glucometers possession (AOR: 2.0 [95% CI: 1.9 to 2.1) and type of mobile phone owned (AOR: 2.9 [95% CI: 2.8 to 5.0]) were significantly associated with the willingness to receive mobile phone-based diabetic services. Conclusion the majority of study participants owned mobile phones and would be willing to receive and pay for diabetes-related healthcare delivery services provided the cost is minimal and affordable.

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“…A plethora of evidence also suggests that active use of diabetes and self-management apps plays an important role in improving clinical and behavioral outcomes of DM [25,26,27,28]. Findings of systematic reviews and meta-analyses of randomized-controlled trials suggested that diabetes apps and digital interventions led to reductions in glycated hemoglobin levels [27,29,30].…”

Section: Introductionmentioning

confidence: 99%

The Role of Continuous Glucose Monitoring, Diabetes Smartphone Applications, and Self-Care Behavior in Glycemic Control: Results of a Multi-National Online Survey

Kebede

Schuett

Pischke

2019

JCM

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Background: This study investigated the determinants (with a special emphasis on the role of diabetes app use, use of continuous glucose monitoring (CGM) device, and self-care behavior) of glycemic control of type 1 and type 2 diabetes mellitus (DM). Methods: A web-based survey was conducted using diabetes Facebook groups, online patient-forums, and targeted Facebook advertisements (ads). Demographic, CGM, diabetes app use, and self-care behavior data were collected. Glycemic level data were categorized into hyperglycemia, hypoglycemia, and good control. Multinomial logistic regression stratified by diabetes type was performed. Results: The survey URL was posted in 78 Facebook groups and eight online forums, and ten targeted Facebook ads were conducted yielding 1854 responses. Of those owning smartphones (n = 1753, 95%), 1052 (62.6%) had type 1 and 630 (37.4%) had type 2 DM. More than half of the type 1 respondents (n = 549, 52.2%) and one third the respondents with type 2 DM (n = 210, 33.3%) reported using diabetes apps. Increased odds of experiencing hyperglycemia were noted in persons with type 1 DM with lower educational status (Adjusted Odds Ratio (AOR) = 1.7; 95% Confidence Interval (CI): 1.21–2.39); smokers (1.63, 95% CI: 1.15–2.32), and high diabetes self-management concern (AOR = 2.09, 95% CI: 1.15–2.32). CGM use (AOR = 0.66, 95% CI: 0.44–1.00); “general diet” (AOR = 0.86, 95% CI: 0.79–0.94); and “blood glucose monitoring” (AOR = 0.88, 95%CI: 0.80–0.97) self-care behavior reduced the odds of experiencing hyperglycemia. Hypoglycemia in type 1 DM was reduced by using CGM (AOR = 0.24, 95% CI: 0.09–0.60), while it was increased by experiencing a high diabetes self-management concern (AOR = 1.94, 95% CI: 1.04–3.61). Hyperglycemia in type 2 DM was increased by age (OR = 1.02, 95% CI: 1.00–1.04); high self-management concern (AOR = 2.59, 95% CI: 1.74–3.84); and poor confidence in self-management capacity (AOR = 3.22, 2.07–5.00). Conversely, diabetes app use (AOR = 0.63, 95% CI: 0.41–0.96) and “general diet” self-care (AOR = 0.84, 95% CI: 0.75–0.94), were significantly associated with the reduced odds of hyperglycemia. Conclusion: Diabetes apps, CGM, and educational interventions aimed at reducing self-management concerns and enhancing dietary self-care behavior and self-management confidence may help patients with diabetes to improve glycemic control.

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Effectiveness of Digital Interventions for Improving Glycemic Control in Persons with Poorly Controlled Type 2 Diabetes: A Systematic Review, Meta-analysis, and Meta-regression Analysis

Abstract: CR. Effectiveness of digital interventions for improving glycemic control in persons with poorly controlled type 2 diabetes: A systematic review, meta-analysis, and meta-regression analysis.

Cited by 106 publications

References 87 publications

Web-Based Interventions for Dietary Behavior in Adults With Type 2 Diabetes: Systematic Review of Randomized Controlled Trials

Web-Based Interventions for Dietary Behavior in Adults With Type 2 Diabetes: Systematic Review of Randomized Controlled Trials

Mobile phone ownership and willingness to receive mHealth services among patients with diabetes mellitus in South-West, Nigeria

The Role of Continuous Glucose Monitoring, Diabetes Smartphone Applications, and Self-Care Behavior in Glycemic Control: Results of a Multi-National Online Survey

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