Diabetes self-management education and support delivered by mobile health (mHealth) interventions for adults with type 2 diabetes: A systematic review and meta-analysis

Abstract

Background: Diabetes self-management education (DSME) and support (DSME/S) delivered via mobile health (mHealth) is potentially cost-effective, if proven effective. Objectives: To assess the effectiveness of DSME, DSMS or DSME/S delivered by mHealth interventions compared to usual care (UC) or attention placebo control (APC) in adults with type 2 diabetes. Methods: We searched (1) MEDLINE, (2) Embase, (3) PsycINFO, (4) Cochrane Central Register of Controlled Trials via the Cochrane Register of Studies Online, (5) ClinicalTrials.gov, and (6) World Health Organization International Clinical Trials Registry Platform from the year 2000 to January 31, 2023. We included RCTs comparing DSME/S delivered via mHealth versus UC or APC. Four authors independently selected trials, assessed risk of bias and extracted data. Primary outcome was HbA1c, outher outcomes secundairy. Meta-analysed with random-effects model was used. Results: We included 43 trials involving 9328 participants; sample sizes ranging from 20 to 1119. Pooled effects on HbA1c were for DSME: mean difference (MD) of −4 mmol/mol (−0.3%), 95% CI −6 mmol/mol (−0.6%) to −1 mmol/mol (−0.1); p = 0.002; DSMS MD −4 mmol/mol (−0.4%), 95% CI 7 mmol/mol (−0.6%) to −2 mmol/mol (−0.2); p < 0.001; and DSME/S MD of −2 mmol/mol (−0.2%) for HbA1c, 95% CI −3 mmol/mol (−0.3%) to −0 mmol/mol (−0.0%); p < 0.001. We found uncertain effects on other outcomes. Conclusions: mHealth interventions delivering self management education with or without support to adults with type 2 diabetes appear to have a modest beneficial effect on HbA1c. Only a few trials investigated patient-reported outcomes.