Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials

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cris.lastimport.scopus2025-08-29T03:10:29Z
dc.abstract.enBackground Digital health interventions have shown promising results for the management of type 2 diabetes, but a comparison of the effectiveness and implementation of the different modes is not currently available. Therefore, this study aimed to compare the effectiveness of SMS, smartphone application, and website-based interventions on improving glycaemia in adults with type 2 diabetes and report on their reach, uptake, and feasibility. Methods In this systematic review and meta-analysis, we searched CINAHL, Cochrane Central, Embase, MEDLINE, and PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) that examined the effectiveness of digital health interventions in reducing glycated haemoglobin A1c (HbA1c) in adults with type 2 diabetes, published in English from Jan 1, 2009. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint assessed was the change in the mean (and 95% CI) plasma concentration of HbA1c at 3 months or more. Cochrane risk of bias 2 was used to assess risk of bias. Data on reach, uptake, and feasibility were summarised narratively and data on HbA1c reduction were synthesised in a meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation criteria was used to evaluate the level of evidence. The study was registered with PROSPERO, CRD42021247845. Findings Of the 3236 records identified, 56 RCTs from 24 regions (n=11 486 participants), were included in the narrative synthesis, and 26 studies (n=4546 participants) in the meta-analysis. 20 studies used SMS as the primary mode of delivery of the digital health intervention, 25 used smartphone applications, and 11 implemented interventions via websites. Smartphone application interventions reported higher reach compared with SMS and website-based interventions, but website-based interventions reported higher uptake compared with SMS and smartphone application interventions. Effective interventions, in general, included people with greater severity of their condition at baseline (ie, higher HbA1c) and administration of a higher dose intensity of the intervention, such as more frequent use of smartphone applications. Overall, digital health intervention group participants had a –0·30 (95% CI –0·42 to –0·19) percentage point greater reduction in HbA1c, compared with control group participants. The difference in HbA1c reduction between groups was statistically significant when interventions were delivered through smartphone applications (–0·42% [–0·63 to –0·20]) and via SMS (–0·37% [–0·57 to –0·17]), but not when delivered via websites (–0·09% [–0·64 to 0·46]). Due to the considerable heterogeneity between included studies, the level of evidence was moderate overall. Interpretation Smartphone application and SMS interventions, but not website-based interventions, were associated with better glycaemic control. However, the studies' heterogeneity should be recognised. Considering that both smartphone application and SMS interventions are effective for diabetes management, clinicians should consider factors such as reach, uptake, patient preference, and context of the intervention when deciding on the mode of delivery of the intervention. Nine in ten people worldwide own a feature phone and can receive SMS and four in five people have access to a smartphone, with numerous smartphone applications being available for diabetes management. Clinicians should familiarise themselves with this modality of programme delivery and encourage people with type 2 diabetes to use evidence-based applications for improving their self-management of diabetes. Future research needs to describe in detail the mediators and moderators of the effectiveness and implementation of SMS and smartphone application interventions, such as the optimal dose, frequency, timing, user interface, and communication mode to both further improve their effectiveness and to increase their reach, uptake, and feasibility. Funding EU's Horizon 2020 Research and Innovation Programme.
dc.affiliationInstytut Psychologii
dc.contributor.authorMoschonis, George
dc.contributor.authorSiopis, George
dc.contributor.authorJung, Jenny
dc.contributor.authorEweka, Evette
dc.contributor.authorWillems, Ruben
dc.contributor.authorKwaśnicka, Dominika
dc.contributor.authorYeboah-Asiamah Asare, Bernard
dc.contributor.authorKodithuwakku, Vimarsha
dc.contributor.authorVerhaeghe, Nick
dc.contributor.authorVedanthan, Rajesh
dc.contributor.authorAnnemans, Lieven
dc.contributor.authorOldenburg, Brian
dc.contributor.authorManios, Yannis
dc.contributor.authorGong, Enying
dc.contributor.authorVotis, Konstantinos
dc.contributor.authorSegkouli, Sofia
dc.contributor.authorTriantafyllidis, Andreas
dc.contributor.authorKyparissis, Odysseas
dc.contributor.authorPaliokas, Ioannis
dc.contributor.authorPolychroniou, Eleftheria
dc.contributor.authorDe Craemer, Dirk
dc.contributor.authorAnastasiou, Kostas
dc.contributor.authorTserpes, Konstantinos
dc.contributor.authorMavrogianni, Christina
dc.contributor.authorKaraglani, Eva
dc.contributor.authorKalogerakou, Electra
dc.contributor.authorMaragkoudaki, Maria
dc.contributor.authorNtzouvani, Agathi
dc.contributor.authorKontochristopoulou, Katerina
dc.contributor.authorDupont, Sabine
dc.contributor.authorDupont, Elizabeth
dc.contributor.authorDauzon, Leo
dc.contributor.authorRoskams, Maartje
dc.contributor.authorLennox-Chhugani, Niamh
dc.contributor.authorPerrin, Martin
dc.contributor.authorDaly Day, Niamh
dc.contributor.authorFerrer, Georgina
dc.contributor.authorSnook, Orla
dc.contributor.authorAldasoro, Edelweiss
dc.contributor.authorGil-Salmerón, Alejandro
dc.contributor.authorGangas Peiró, Pilar
dc.contributor.authorCurran, Darren
dc.contributor.authorLyne, Fiona
dc.contributor.authorCurreri, Nereide A.
dc.contributor.authorPierantozzi, Nazzareno
dc.contributor.authorD'Antonio, Claudia
dc.contributor.authorVespasiani, Giacomo
dc.contributor.authorAlmonti, Teresa
dc.contributor.authorSkouteris, Helen
dc.contributor.authorTaylor, Tracy
dc.contributor.authorSavaglio, Melissa
dc.contributor.authorMakrilakis, Konstantinos
dc.contributor.authorStergiou, George
dc.contributor.authorLiatis, Stavros
dc.contributor.authorKaramanakos, George
dc.contributor.authorKoliaki, Chrysi
dc.contributor.authorKollias, Anastasios
dc.contributor.authorZikou, Eva
dc.contributor.authorDimosthenopoulos,
dc.contributor.authorHuang, Keng-Yen
dc.contributor.authorAdhikari, Samrachana
dc.contributor.authorQian, Kun
dc.contributor.authorDickhaus, Julia
dc.contributor.authorCarney, Kimberly
dc.contributor.authorSahito, Farhan
dc.contributor.authorPavlovic, Dusan
dc.contributor.authorDjokic, Djordje
dc.contributor.authorSahito, Arzoo
dc.contributor.authorBattalova, Gisella
dc.contributor.authorSeghieri, Chiara
dc.contributor.authorNutti, Sabina
dc.contributor.authorVanieri, Milena
dc.contributor.authorBelle, Nicola
dc.contributor.authorBertarelli, Gaia
dc.contributor.authorCantarelli, Paola
dc.contributor.authorFerre, Francesca
dc.contributor.authorNoci, Anna
dc.contributor.authorTortu, Constanza
dc.contributor.authorBozzi, Nadia
dc.contributor.authorFerrari, Dina
dc.contributor.authorBorelli, Rachele
dc.contributor.authorIotova, Violeta
dc.contributor.authorYotov, Yoto
dc.contributor.authorUsheva, Natalia
dc.contributor.authorKozhuharova, Anna
dc.contributor.authorRusseva, Vanya
dc.contributor.authorMarinova, Vanya
dc.contributor.authorKoleva, Sonya
dc.contributor.authorAtanasova, Virginia
dc.contributor.authorStefanova, Tanya
dc.contributor.authorTsochev, Kaloyan
dc.contributor.authorMoreno Aznar, Luis
dc.contributor.authorMagallón Botaya, Rosa
dc.contributor.authorBueno Lozano, Gloria
dc.contributor.authorDe Miguel-Etayo, Pilar
dc.contributor.authorMa Gonzalez-Gil, Esther
dc.contributor.authorMiguel-Berges, María L.
dc.contributor.authorPérez, Susana
dc.contributor.authorOliván Blázquez, Bárbara
dc.contributor.authorGiménez-Legarre, Natalia
dc.contributor.authorToti, Florian
dc.contributor.authorPrifti, Skerdi
dc.contributor.authorBombaj, Blerina
dc.contributor.authorDoracaj, Ditila
dc.contributor.authorLaze, Ornela
dc.contributor.authorLapardhaja, Adriana
dc.contributor.authorBruka, Luftime
dc.date.access2023-03
dc.date.accessioned2023-10-19T10:13:36Z
dc.date.available2023-10-19T10:13:36Z
dc.date.created2023-03-01
dc.date.issued2023-03
dc.description.accesstimeat_publication
dc.description.issue3
dc.description.physical125-143
dc.description.versionfinal_published
dc.description.volume5
dc.identifier.doi10.1016/S2589-7500(22)00233-3
dc.identifier.issn2589-7500
dc.identifier.urihttps://share.swps.edu.pl/handle/swps/89
dc.identifier.weblinkhttps://www.thelancet.com/journals/landig/article/PIIS2589-7500(22)00233-3/fulltext
dc.languageen
dc.pbn.affiliationpsychologia
dc.rightsCC-BY
dc.rights.questionYes_rights
dc.share.articleOPEN_JOURNAL
dc.swps.sciencecloudsend
dc.titleEffectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials
dc.title.journalThe Lancet Digital Health
dc.typeJournalArticle
dspace.entity.typeArticle