A Digital Lifestyle Program in Outpatient Treatment of Type 2 Diabetes: A Randomized Controlled Study

Methodological approaches and author-reported limitations in evaluation studies of digital health technologies (DHT): A scoping review of DHT interventions for cancer, diabetes mellitus, and cardiovascular diseases

Digital health technology (DHT) holds the potential to improve health services, and its adoption has proliferated in recent decades owing to technological advancement. Optimal evaluation methodologies appropriate for generating quality evidence on DHT have yet to be established; traditional comparative designs present several limitations. This study aimed to scope the literature to highlight common methodological approaches used and their limitations to inform considerations for designing robust DHT evaluation studies. A scoping review was conducted following the Joanna Briggs Institute (JBI) scoping review guidelines. A systematic search was conducted using the CINAHL (EBSCO), MEDLINE (EBSCOhost), PsycINFO (EBSCO), EMBASE (Elsevier) and Web of Science (Clarivate Analytics) databases using iteratively developed search terms. We selected studies published in English between January 2016 and March 2022 and focussed on primary research evaluating the effectiveness of DHT with technology-user interactive or asynchronous features for adults (≥18 years) with cancer, diabetes or cardiovascular conditions. The final number of articles, after the screening and selection process, comprised 140 records. Data were analysed descriptively (frequency and percentages) and summarised thematically. Results showed most studies (n = 104, 74.3%) employed the standard two-arm parallel RCT design, with usual/standard care as the preferred comparator in nearly half (n = 65, 47.1%) of all included studies. Of the 104 comparative studies reviewed, limitations in recruitment were most frequently reported (n = 70, 37%), followed by limitations in evaluation/measurement techniques (n = 57, 27%), presence of confounding factors (n = 50, 24%) and short duration of studies (n = 24, 11%). The review highlights the need to consider inclusive approaches to recruitment and adoption of the emerging methodological approaches that account for the fast-paced, multi-component and group contamination problem resulting from the unconcealable nature of DHT interventions.

Effectiveness of Digital Lifestyle Interventions on Depression, Anxiety, Stress, and Well-Being: Systematic Review and Meta-Analysis

BACKGROUND

There is a growing body of robust evidence to show that lifestyle behaviors influence mental health outcomes. Technology offers an accessible and cost-effective implementation method for interventions, yet the study of the effectiveness of interventions to date has been specific to the mode of delivery, population, or behavior.

OBJECTIVE

The primary aim of this review was to comprehensively evaluate the effectiveness of digital lifestyle interventions for improving symptoms of depression, anxiety, stress, and well-being as coprimary outcomes in adults. The secondary aim was to explore the technological, methodological, intervention-specific, and population-specific characteristics that were associated with major changes in mental health outcomes.

METHODS

A systematic search was conducted across the MEDLINE, CINAHL, Embase, Emcare, PsycINFO, and Scopus databases to identify studies published between January 2013 and January 2023. Randomized controlled trials of lifestyle interventions (physical activity, sleep, and diet) that were delivered digitally; reported changes in symptoms of depression, anxiety, stress, or well-being in adults (aged ≥18 years); and were published in English were included. Multiple authors independently extracted data, which was evaluated using the 2011 Levels of Evidence from the Oxford Centre for Evidence-Based Medicine. Inverse-variance random-effects meta-analyses were used for data analysis. The primary outcome was the change in symptoms of depression, anxiety, stress, and well-being as measured by validated self-report of clinician-administered outcomes from pre- to postintervention. Subgroup analyses were conducted to determine whether results differed based on the target lifestyle behavior, delivery method, digital features, design features, or population characteristics.

RESULTS

Of the 14,356 studies identified, 61 (0.42%) were included. Digital lifestyle interventions had a significant small-to-medium effect on depression (standardized mean difference [SMD] -0.37; P<.001), a small effect on anxiety (SMD -0.29; P<.001) and stress (SMD -0.17; P=.04), and no effect on well-being (SMD 0.14; P=.15). Subgroup analyses generally suggested that effects were similar regardless of the delivery method or features used, the duration and frequency of the intervention, the population, or the lifestyle behavior targeted.

CONCLUSIONS

Overall, these results indicate that delivering lifestyle interventions via a range of digital methods can have significant positive effects on depression (P<.001), anxiety (P<.001), and stress (P=.04) for a broad range of populations, while effects on well-being are inconclusive. Future research should explore how these interventions can be effectively implemented and embedded within health care with a concerted focus on addressing digital health equity.

TRIAL REGISTRATION

PROSPERO CRD42023428908; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023428908.

Technological functionality and system architecture of mobile health interventions for diabetes management: a systematic review and meta-analysis of randomized controlled trials

Introduction

Despite advancements in digital health, systematic evaluations of mobile applications (Apps) for diabetes management are limited.

Methods

Researchers conducted searches on PUBMED, EMBASE, COCHRANE, SCOPUS, and WEB OF SCIENCE from inception to August 2024. The researchers included randomized controlled trials (RCTs) that investigated the effectiveness of app-based interventions in health management among diabetic patients. Reviewers were paired and independently conducted the screening of studies, data extraction, and evaluation of study quality. The primary outcome of interest was the modification of hemoglobin A1c (HbA1c). The researchers utilized a random effects model to calculate the weighted mean differences (WMDs) and 95% confidence intervals (CIs) and used the I2 statistic to assess study heterogeneity. Publication bias for the primary outcomes underwent assessment. Studies were Appraised for quality using the Cochrane Risk of Bias assessment.

Results

41 studies of 3911 initially identified articles that met the selection criteria. The results showed that Apps' intervention significantly improved glycemic control in diabetic patients, with a mean reduction in HbA1c levels of 0.49% (95%CI: -0.65 to -0.32%) compared to standard care. The analysis also revealed that Apps enhanced patient self-management behaviors. Subgroup analyses failed to resolve heterogeneity, but studies consistently observed improved HbA1c levels. The quality assessment results indicated that most studies performed well in the completeness of outcome data and selective reporting.

Discussion

This meta-analysis confirms that mobile health applications with practical technological functionalities and system architectures are beneficial in managing diabetes. These applications significantly reduced HbA1c levels and improved self-management behaviors. Although some studies exhibited a moderate risk of bias, the overall evidence supports using these applications as valuable tools in diabetes care. Future research should standardize application features, refine system architectures, and address bias issues to enhance.

Systematic Review Registration

PROSPERO (CRD42023441365).

Effect of Multimodal App-Based Interventions on Glycemic Control in Patients With Type 2 Diabetes: Systematic Review and Meta-Analysis

BACKGROUND

Digital technologies for type 2 diabetes mellitus (T2DM) care hold great potential to improve patients' health in the long term. Only a subset of telemedicine offerings are digital interventions that meet the criteria for prescribable digitale Gesundheitsanwendung (digital health apps; DiGAs) in Germany. Digital treatments further provide vast amounts of patient data that are important to generate evidence.

OBJECTIVE

This systematic review aims to analyze the efficacy of multimodal digital therapies that mainly meet the DiGA criteria for patients with T2DM and to elicit the potential of such therapies. This includes evidence from randomized controlled trials (RCTs) as well as from real-world data. The outcome of interest was a reduction in glycated hemoglobin (hemoglobin A1c [HbA1c]; long-term blood glucose measurements).

METHODS

A systematic literature search was conducted in the literature bases PubMed, LIVIVO, and Cochrane, based on the predefined PICO (Population; Intervention; Control; Outcome) scheme. Identified studies were assessed for risk of bias, pragmatism, and overall quality of evidence. Meta-analyses were conducted for between group differences using RCTs only, and for within-group differences using RCTs and non-RCTs, to examine the effect of the interventions on HbA1c.

RESULTS

In total, 795 records were identified, of which 24 were eligible for this systematic review and 23 studies were eligible for the meta-analysis. The results of the meta-analyses showed significant and clinically relevant reductions in HbA1c in patients with T2DM. Regarding the between-group difference for HbA1c reduction, the pooled effect of the RCTs showed a reduction of -0.36% (95% CI -0.59% to -0.14%; P<.001), favoring app-based interventions. The average mean within-group reduction in HbA1c was -0.79 (95% CI -1.02 to -0.55), with no significant difference between RCTs (-0.69, 95% CI -1.13 to -0.24) and non-RCTs (-0.87, 95% CI -1.16 to -0.57; P<.01, differences between RCTs and RCTs P=.44). A pragmatism rating showed that both study types were on average (very) pragmatic, that is, close to usual care. However, the overall quality of evidence was low to very low.

CONCLUSIONS

This systematic review shows that digital therapies that mainly meet the DiGA criteria can effectively improve HbA1c in patients with T2DM. The integration of digital health care into usual care holds great potential and should be considered as a complementary option to usual care in the future.

TRIAL REGISTRATION

PROSPERO CRD42023440203; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=440203.

Evaluating clinical guidelines for chronic disease management: Do they enable the personalization of care?

OBJECTIVE

To described how general practitioners (GPs) personalize interventions for patients with chronic diseases and compare practice with the corresponding guidelines.

STUDY DESIGN

Scoping review followed by a multicentre cross-sectional study in French general practices.

METHODS

We identified elements of personalization described in guidelines related to diabetes, hypertension, dyslipidaemia, insomnia and depression. Then, GPs completed questionnaires for pharmacological (PI) and non-pharmacological interventions (NPI) after any consultation for these diseases to collect: when, on which the variables (clinical, biological characteristics, etc.), how and by whom the interventions were personalized, and what was personalized in the interventions. Agreement between GPs' practices and guidelines was analyzed using Cohen's Kappa.

RESULTS

We extracted 204 elements of personalization in 10 guidelines, and GPs described 1512 elements of personalization in 161 PI and 1313 elements in 131 NPI. Personalization was mainly based on patients' general characteristics (20.6 % of PT; 24.8 % of NPI) and treatments characteristics (14.5 % of PI; 9.8 % of NPI). GPs accounted for patients' preferences in 64.6 % of PI and 79.4 % of NPI. For PI, the agreement between GPs and guidelines was globally low (kappa = 0.21[0.11; 0.31]) but moderate for treatment characteristics (kappa = 0.48 [0.09; 0.87]) and high for disease characteristics (kappa = 1.00[1.00; 1.00]). For NPI, agreement was globally very low (kappa = 0.16[0.10; 0.25]) but moderate for treatment characteristics (kappa = 0.59[0.19; 1.00]) and disease characteristics (kappa = 0.48[0.12; 0.87]).

CONCLUSIONS

Guidelines insufficiently described the tailoring variables and the subsequent modifications of the interventions. They need to be better described to promote a medicine that is both personalized to each patient and homogeneous between physicians.

Benchmarking the clinical outcomes of Healthentia SaMD in chronic disease management: a systematic literature review comparison

Background

Software as a Medical Device (SaMD) and mobile health (mHealth) applications have revolutionized the healthcare landscape in the areas of remote patient monitoring (RPM) and digital therapeutics (DTx). These technological advancements offer a range of benefits, from improved patient engagement and real-time monitoring, to evidence-based personalized treatment plans, risk prediction, and enhanced clinical outcomes.

Objective

The systematic literature review aims to provide a comprehensive overview of the status of SaMD and mHealth apps, highlight the promising results, and discuss what is the potential of these technologies for improving health outcomes.

Methods

The research methodology was structured in two phases. In the first phase, a search was conducted in the EuropePMC (EPMC) database up to April 2024 for systematic reviews on studies using the PICO model. The study population comprised individuals afflicted by chronic diseases; the intervention involved the utilization of mHealth solutions in comparison to any alternative intervention; the desired outcome focused on the efficient monitoring of patients. Systematic reviews fulfilling these criteria were incorporated within the framework of this study. The second phase of the investigation involved identifying and assessing clinical studies referenced in the systematic reviews, followed by the synthesis of their risk profiles and clinical benefits.

Results

The results are rather positive, demonstrating how SaMDs can support the management of chronic diseases, satisfying patient safety and performance requirements. The principal findings, after the analysis of the extraction table referring to the 35 primary studies included, are: 24 studies (68.6%) analyzed clinical indications for type 2 diabetes mellitus (T2DM), six studies (17.1%) analyzed clinical indications for cardiovascular conditions, three studies (8.7%) analyzed clinical indications for cancer, one study (2.8%) analyzed clinical indications for chronic obstructive pulmonary disease (COPD), and one study (2.8%) analyzed clinical indications for hypertension. No severe adverse events related to the use of mHealth were reported in any of them. However, five studies (14.3%) reported mild adverse events (related to hypoglycemia, uncontrolled hypertension), and four studies (11.4%) reported technical issues with the devices (related to missing patient adherence requirements, Bluetooth unsuccessful pairing, and poor network connections). For what concerns variables of interest, out of the 35 studies, 14 reported positive results on the reduction of glycated hemoglobin (HbA1c) with the use of mHealth devices. Eight studies examined health-related quality of life (HRQoL); in three cases, there were no statistically significant differences, while the groups using mHealth devices in the other five studies experienced better HRQoL. Seven studies focused on physical activity and performance, all reflecting increased attention to physical activity levels. Six studies addressed depression and anxiety, with mostly self-reported benefits observed. Four studies each reported improvements in body fat and adherence to medications in the mHealth solutions arm. Three studies examined blood pressure (BP), reporting reduction in BP, and three studies addressed BMI, with one finding no statistically significant change and two instead BMI reduction. Two studies reported significant weight/waist reduction and reduced hospital readmissions. Finally, individual studies noted improvements in sleep quality/time, self-care/management, six-minute walk distance (6MWD), and exacerbation outcomes.

Conclusion

The systematic literature review demonstrates the significant potential of software as a medical device (SaMD) and mobile health (mHealth) applications in revolutionizing chronic disease management through remote patient monitoring (RPM) and digital therapeutics (DTx). The evidence synthesized from multiple systematic reviews and clinical studies indicates that these technologies, exemplified by solutions like Healthentia, can effectively support patient monitoring and improve health outcomes while meeting crucial safety and performance requirements. The positive results observed across various chronic conditions underscore the transformative role of digital health interventions in modern healthcare delivery. However, further research is needed to address long-term efficacy, cost-effectiveness, and integration into existing healthcare systems. As the field rapidly evolves, continued evaluation and refinement of these technologies will be essential to fully realize their potential in enhancing patient care and health management strategies.

Prognostic effectiveness of interactive vs. non-interactive mobile app interventions in type 2 diabetes: a systematic review and meta-analysis

BACKGROUND

Mobile app interventions are emerging as significant tools in managing the prognosis of type 2 diabetes, demonstrating progressively greater impacts. The effectiveness of these interventions needs further evidence-based support.

OBJECTIVE

This study conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the effectiveness of mobile app interventions in improving prognosis for patients with type 2 diabetes.

METHODS

We searched PubMed, Cochrane, Embase, and Web of Science for relevant studies published from inception to 18 April 2024, adhering to the Cochrane Handbook guidelines. The quality of the included studies was assessed using the Cochrane risk of bias tool. Primary outcomes measured were changes in glycated hemoglobin (HbA1c) and diabetes self-management (DSM). Secondary outcomes included changes in diastolic blood pressure (DBP), systolic blood pressure (SBP), triglycerides(TG), total cholesterol(TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), lipid profiles, fasting plasma glucose (FPG), body mass index (BMI), and Steps outcomes. Subgroup analyses were performed for the primary outcomes and for high-density lipoprotein (HDL), low-density lipoprotein (LDL), diastolic blood pressure (DBP), and systolic blood pressure (SBP). Interventions with or without interactions were also used as a basis for subgrouping.

RESULTS

A total of 15 eligible articles involving 17 studies with 2,028 subjects (1,123 in the intervention group and 1,020 in the control group) were included in the synthesis. Interactive mobile app interventions significantly reduced HbA1c levels (SMD - 0.24; 95% CI, -0.33 to -0.15; P < 0.00001) and significantly improved diabetes self-care (SMD 0.71; 95% CI, 0.21 to 1.21; P = 0.005). Secondary outcomes, including FPG, LDL, DBP, and SBP, showed varying degrees of improvement. Subgroup analyses indicated that the intervention effect was more pronounced and less heterogeneous in the short-term (≤ 3 months) for younger Asian individuals (< 55 years) who used an interactive mobile app.

CONCLUSION

Interactive mobile app interventions effectively improve HbA1c levels and diabetes self-care competencies in patients with type 2 diabetes. These interventions offer supportive evidence for their clinical use in managing and prognosticating type 2 diabetes.

SYSTEMATIC REVIEW REGISTRATION

CRD42024550643.

The Effect of Lifestyle Interventions on Anxiety, Depression and Stress: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

BACKGROUND/OBJECTIVES

Depression, anxiety, and stress are common mental health issues that affect individuals worldwide. This systematic review and meta-analysis examined the effectiveness of various lifestyle interventions including physical activity, dietary changes, and sleep hygiene in reducing the symptoms of depression, anxiety, and stress. Using stress as an outcome and conducting detailed subgroup analyses, this study provides novel insights into the differential effects of lifestyle interventions across diverse populations.

METHODS

Five databases were systematically searched: PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, for gray literature searches. Keywords were used to search each database. The search period was from the conception of the databases until August 2023 and was conducted in English. For each analysis, Hedges' g was reported with a 95% confidence interval (CI) based on the random-effects method. Subgroups were analyzed and heterogeneity and publication bias were examined.

RESULTS

Ninety-six randomized clinical trial studies were included in this meta-analysis. Lifestyle interventions reduced depression (Hedges g -0.21, 95% confidence interval -0.26, -0.15; p < 0.001; I2 = 56.57), anxiety (Hedges g -0.24, 95% confidence interval -0.32, -0.15; p < 0.001; I2 = 59.25), and stress (-0.34, -0.11; p < 0.001; I2 = 61.40).

CONCLUSIONS

Lifestyle interventions offer a more accessible and cost-effective alternative to traditional treatments and provide targeted benefits for different psychological symptoms.

A Systematic Review of Telehealth Applications in Endocrinology

Introduction

The prevalence of telehealth has witnessed a significant increase in various medical domains, especially in endocrinology. Telehealth brings about considerable advantages for both patients and health care professionals. However, despite these positive aspects, the growing prominence of telehealth is accompanied by certain challenges. This systematic review aims to assess the role of telehealth in endocrinology, including its applications, effectiveness, challenges, and implications for patient care.

Methods

This study involved a thorough search using comprehensive techniques across databases such as PubMed/Medline, Embase, and Scopus. The studies were selected for a tailored adaptation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to enhance the clarity of our systematic review's reporting.

Results

This systematic review explores global telemedicine applications in endocrinology. Addressing various endocrine conditions, interventions utilize technology tools such as smartphones and applications, offering multifaceted utility from education and data gathering to screening and treatment. Notably, these interventions demonstrate adaptability during the COVID-19 pandemic. Positive outcomes include enhanced patient education, disease self-management, reduced complications, and improved glycemic control. However, drawbacks include the need for technical proficiency, perceived lower care quality, and potential privacy risks. These nuanced findings contribute to the discourse on telemedicine efficacy and limitations.

Conclusion

In conclusion, telehealth holds significant potential in transforming endocrine care. While there are challenges to its implementation, the benefits it offers underscore its value as a health care delivery model.

Lifestyle interventions improving health-related quality of life: A systematic review and meta-analysis of randomized control trials

Lifestyle interventions have garnered significant research interest for their potential to enhance health-related quality of life (HRQoL). Understanding the impact of these interventions on various dimensions of HRQoL is crucial for effective healthcare strategies. This study aims to systematically review and meta-analyze the effects of lifestyle interventions on HRQoL in randomized control trials. A systematic search was conducted across five scientific databases, including PubMed, Web of Science, Scopus, the Cochrane Library, and gray literature, with a filter applied to include only English language publications. Study selection was carried out by two independent reviewers in several steps, including duplicate removal and eligibility evaluation for meta-analysis. Information extracted from the studies included authors, countries, study designs, target populations, ages, genders, number of participants, interventions, outcomes, and results. A total of 61 randomized control trials were included in this meta-analysis. The meta-analysis revealed that lifestyle interventions significantly improved healthrelated quality of life compared to control groups, with Hedges' g of 0.38 (95% CI 0.25-0.50, Z = 5.94; P < 0.001; I2 = 84.59%). This positive effect was consistently observed in patients with heart-related diseases and metabolic disorders. Meta-regression analysis indicated that lifestyle interventions had the most substantial impact on health-related quality of life in the 1-month follow-up period. Considering the cost-effectiveness of lifestyle interventions compared to other intervention types, they can benefit various patient groups. This systematic review contributes to health policy goals by advocating focused preventive strategies in alignment with the observed benefits of lifestyle interventions.

Effects of digital self-care intervention for Korean older adults with type 2 diabetes: A randomized controlled trial over 12 weeks

This study developed and assessed the impact of a digitally enabled self-care intervention program tailored for older adults with type 2 diabetes led by nursing professionals. A randomized controlled trial of a 12-week digital self-care intervention was conducted with 105 older Korean adults with type 2 diabetes. The intervention involved self-recording in the DiaNote application, newly developed for the study and a phone visit. Participants were randomly allocated to DiaNote or traditional logbook groups. Outcomes were collected at baseline and again after 12 weeks. Generalized estimating equations indicated that HbA1c level changes over time significantly in DiaNote group. Diabetes self-care activities and quality of life changed over time in both groups. Self-efficacy did not significantly differ between groups or over time. The digital self-care intervention was beneficial for blood sugar control, being equivalent to using a traditional diabetes logbook for quality of life and diabetic self-care.

Dropout rate in clinical trials of smartphone apps for diabetes management: A meta-analysis

Applicability of smartphone-based digital health in diabetes management still face challenges due tolow user retention or engagement. Thus, this systematic and meta-analysis aimed to estimate the dropout rate from the clinical trials. Search of literature was performedon 4 September 2023 through various databases (PubMed, Scilit, Scopus, Embase, and Web of Science). Those reporting clinical trials of smartphone apps for diabetic controls (either type 1 or type 2 diabetes mellitus) were screened and selected in accordance with PRISMA guideline. Of 5,429 identified records, as many as 36 studies were found eligible with a total of 3,327 patients in the intervention group. The overall dropout rate was 29.6 % (95 %CI: 25 %-34.3 %) with high heterogeneity (p-Het < 0.001;I2 = 84.84 %). Sample size, intervention duration, patients' age and gender, and cultural adaptation on the app appeared to be non-significant moderators (p > 0.05). In sub-group levels, notably high dropout rates were observed in studies performing cultural adaptation (34.6 %) and conducted in high-income countries (31.9 %). Given the high dropout rate, the engagement level toward diabetic management apps in real-world setting is expected to be low. High heterogeneity in this study, however, requires careful interpretation of the foregoing results. PROSPERO: CRD42023460365 (14 September 2023).

Are e-Health Interventions Effective in Reducing Diabetes-Related Distress and Depression in Patients with Type 2 Diabetes? A Systematic Review with Meta-Analysis

Background: e-Health refers to any health care service delivered through the internet or related technologies, to improve quality of life. Despite the increasing use of e-health interventions to manage type 2 diabetes (T2D), there is a lack of evidence about the effectiveness on diabetes distress and depression, which are common issues in those living with T2D. Purpose: To synthesize and determine the effects of e-health interventions on diabetes distress and depression among patients with T2D. Methods: We systematically searched PubMed, Scopus, Cochrane CENTRAL, and Web of Science for randomized controlled trials (RCTs), non-RCTs and observational cohort studies for the effects of e-health interventions on diabetes distress and depression in patients with T2D up to September 14, 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 recommendations were followed. The risk of bias was assessed according to the Risk-of-Bias 2 tool (RCTs), the Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I) (non-RCTs) and the National Institute of Health tool (observational). The standardized mean difference (SMD) and its related 95% confidence intervals (CIs) were estimated with the DerSimonian-Laird method through random-effect models. A pooled raw mean difference (MD) meta-analysis was conducted for RCTs comparing the effects of e-health versus control on diabetes distress screening to display the clinical impact. Results: A total of 41 studies (24 RCTs, 14 non-RCTs, and 3 observational) involving 8,667 individuals were included. The pooled SMD for the effect of e-health versus the control group on diabetes distress was -0.14 (95% CI = -0.24 to -0.04; I2 = 23.9%; n = 10 studies), being -0.06 (95% CI = -0.15 to 0.02; I2 = 7.8%; n = 16 studies) for depression. The pooled raw MD on diabetes distress screening showed a reduction of -0.54 points (95% CI = -0.81 to -0.27; I2 = 85.1%; n = 7 studies). Conclusion: e-Health interventions are effective in diminishing diabetes distress among adults with T2D, inducing clinically meaningful reductions.

Efficacy of a Digital Diabetes Logbook for People With Type 1, Type 2, and Gestational Diabetes: Results From a Multicenter, Open-Label, Parallel-Group, Randomized Controlled Trial

BACKGROUND

In a randomized controlled trial, the efficacy of a digital diabetes diary regarding a reduction of diabetes distress was evaluated.

METHODS

A randomized controlled trial with a 12-week follow-up was conducted in 41 study sites across Germany. Key eligibility criteria were a diagnosis of type 1, type 2, or gestational diabetes and regular self-monitoring of blood glucose. Participants were randomly assigned (2:1 ratio) to either use the digital diabetes logbook (mySugr PRO), or to the control group without app use. The primary outcome was the reduction in diabetes distress at the 12-week follow-up. All analyses were based on the intention-to-treat population with all randomized participants. The trial was registered at the German Register for Clinical Studies (DRKS00022923).

RESULTS

Between February 11, 2021, and June 24, 2022, 424 participants (50% female, 50% male) were included, with 282 being randomized to the intervention group (66.5%) and 142 to the control group (33.5%). A total of 397 participants completed the trial (drop-out rate: 6.4%). The median reduction in diabetes distress was 2.41 (interquartile range [IQR]: -2.50 to 8.11) in the intervention group and 1.25 (IQR: -5.00 to 7.50) in the control group. The model-based adjusted between-group difference was significant (-2.20, IQR: -4.02 to -0.38, P = .0182) favoring the intervention group. There were 27 adverse events, 17 (6.0%) in the intervention group, and 10 (7.0%) in the control group.

CONCLUSIONS

The efficacy of the digital diabetes logbook was demonstrated regarding improvements in mental health in people with type 1, type 2, and gestational diabetes.

Knowledge, attitudes and practices among medical workers toward outpatient diabetes information platform

BACKGROUND

This study aimed to assess the knowledge, attitudes and practices among medical workers toward outpatient diabetes information platform.

METHODS

This web-based cross-sectional study was conducted between May 2023 and June 2023 at the First Hospital of Zhangjiakou, China. A self-designed questionnaire was developed to collect demographic information of medical workers, and assess their knowledge, attitudes and practices toward outpatient diabetes information platform.

RESULTS

A total of 685 questionnaires were collected. Among the participants, 603 (88.03%) were female, 432 (63.07%) work in a tertiary hospital, 548 (80.00%) have a bachelor degree, 270 (39.42%) of them work in the department of internal medicine and 315 (45.99%) of them received previous training on outpatient diabetes information platform. The mean knowledge, attitudes and practices scores were 4.32 ± 1.27 (possible range: 0-6), 56.76 ± 5.72 (possible range: 14-70), and 32.22 ± 8.42 (possible range: 9-45), respectively. 350 (51.09%) of them have sufficient knowledge, 168 (24.53%) have positive attitudes and 395 (57.66%) have active practices. Pearson correlation analysis showed that knowledge was positively correlated with attitudes (r = 0.397, P < 0.001), and attitudes were positively correlated with practices (r = 0.306, P < 0.001). Multivariate analysis showed that primary hospital (OR = 0.32, 95% CI: 0.14-0.71, P = 0.005), secondary hospital (OR = 0.48, 95% CI: 0.32-0.72, P < 0.001), doctor (OR = 2.44, 95% CI: 1.39-4.28, P = 0.002) were independently associated with sufficient knowledge. Knowledge (OR = 1.49, 95% CI: 1.29-1.73, P < 0.001), community hospital staff (OR = 0.21, 95% CI: 0.05-0.88, P = 0.032) were independently associated with positive attitudes. Attitudes (OR = 1.13, 95% CI: 1.09-1.17, P < 0.001), junior college (OR = 1.72, 95% CI: 1.07-2.77, P = 0.026) were independently associated with active practices. The structural equation model demonstrated that knowledge had a direct effect on attitudes (path coefficient = 0.521, P < 0.001), and attitudes had a direct effect on practices (path coefficient = 0.542, P < 0.001). Moreover, the type of hospital had a direct effect on knowledge (path coefficient = 0.085, P < 0.001). Additionally, previous training on the outpatient diabetes platform had direct effects on attitudes (path coefficient = 0.191, P < 0.001) and practices (path coefficient = 0.184, P < 0.001).

CONCLUSION

These findings revealed that medical workers have insufficient knowledge, positive attitudes and inactive practices toward the outpatient diabetes information platform. Comprehensive training programs are needed to improve medical staff's practices in this area.

Mind-body internet and mobile-based interventions for depression and anxiety in adults with chronic physical conditions: A systematic review of RCTs

This review summarizes the effectiveness of scalable mind-body internet and mobile-based interventions (IMIs) on depression and anxiety symptoms in adults living with chronic physical conditions. Six databases (MEDLINE, PsycINFO, SCOPUS, EMBASE, CINAHL, and CENTRAL) were searched for randomized controlled trials published from database inception to March 2023. Mind-body IMIs included cognitive behavioral therapy, breathwork, meditation, mindfulness, yoga or Tai-chi. To focus on interventions with a greater potential for scale, the intervention delivery needed to be online with no or limited facilitation by study personnel. The primary outcome was mean change scores for anxiety and depression (Hedges' g). In subgroup analyses, random-effects models were used to calculate pooled effect size estimates based on personnel support level, intervention techniques, chronic physical condition, and survey type. Meta-regression was conducted on age and intervention length. Fifty-six studies met inclusion criteria (sample size 7691, mean age of participants 43 years, 58% female): 30% (n = 17) neurological conditions, 12% (n = 7) cardiovascular conditions, 11% cancer (n = 6), 43% other chronic physical conditions (n = 24), and 4% (n = 2) multiple chronic conditions. Mind-body IMIs demonstrated statistically significant pooled reductions in depression (SMD = -0.33 [-0.40, -0.26], p<0.001) and anxiety (SMD = -0.26 [-0.36, -0.17], p<0.001). Heterogeneity was moderate. Scalable mind-body IMIs hold promise as interventions for managing anxiety and depression symptoms in adults with chronic physical conditions without differences seen with age or intervention length. While modest, the effect sizes are comparable to those seen with pharmacological therapy. The field would benefit from detailed reporting of participant demographics including those related to technological proficiency, as well as further evaluation of non-CBT interventions. Registration: The study is registered with PROSPERO ID #CRD42022375606.

The effect of lifestyle interventions on depressive symptom severity in individuals with type-2 diabetes: A meta-analysis of randomized controlled trials

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a severe metabolic condition which is commonly comorbid with depression. Lifestyle factors are involved in the pathophysiology of both conditions; however, the role of lifestyle interventions remains unclear.

OBJECTIVE

The objective of this study is to systematically review the literature on randomized controlled trials evaluating the effect of lifestyle interventions on depressive scores in patients with T2DM.

METHODS

A systematic search was conducted in computerized databases before October 2022. A random-effects model was used to investigate the effect of lifestyle interventions on depression scores and meta-regression was conducted to assess the influence of age and disease onset.

RESULTS

Six trials met the eligibility criteria for inclusion. A statistically significant reduction in depression scores was found for groups receiving lifestyle interventions compared to controls (SMD = -0.49 [95%CI -0.89 to -0.08]; p = 0.0269]). Interventions increased in efficacy with the age of the participants but no significant correlation was found with years since disease onset. Participants in a control group receiving a less intense lifestyle intervention demonstrated improved depression scores when compared to those who received standard care or no intervention at all. Trial design and outcome measurement tools were heterogeneous between studies and limited data on antidepressant use was available which may introduce bias into the results.

CONCLUSION

Lifestyle interventions were effective at improving depressive symptom severity in patients with T2DM.

Real-World Evidence of a Hospital-Linked Digital Health App for the Control of Hypertension and Diabetes Mellitus in South Korea: Nationwide Multicenter Study

BACKGROUND

Digital health care apps have been widely used for managing chronic conditions such as diabetes mellitus and hypertension, providing promising prospects for enhanced health care delivery, increased patient engagement, and improved self-management. However, the impact of integrating these apps within hospital systems for managing such conditions still lacks conclusive evidence.

OBJECTIVE

We aimed to investigate the real-world effectiveness of using hospital-linked digital health care apps in lowering blood pressure (BP) and blood glucose levels in patients with hypertension and diabetes mellitus.

METHODS

Nationwide multicenter data on demographic characteristics and the use of a digital health care app from 233 hospitals were collected for participants aged 20 to 80 years in South Korea between August 2021 and June 2022. We divided the participants into 2 groups: 1 group consisted of individuals who exclusively used the digital health app (control) and the other group used the hospital-linked digital health app. All the patients participated in a 12-week digital health care intervention. We conducted a comparative analysis to assess the real-world effectiveness of the hospital-linked digital health app. The primary outcome was the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) level, and postprandial glucose (PPG) level between baseline and 12 weeks.

RESULTS

A total of 1029 participants were analyzed for the FBG level, 527 participants were analyzed for the PPG level, and 2029 participants for the SBP and DBP were enrolled. After 12 weeks, a hospital-linked digital health app was found to reduce SBP (-5.4 mm Hg, 95% CI -7.0 to -3.9) and DBP (-2.4 mm Hg, 95% CI -3.4 to -1.4) in participants without hypertension and FBG level in all participants (those without diabetes, -4.4 mg/dL, 95% CI -7.9 to -1.0 and those with diabetes, -3.2 mg/dL, 95% CI -5.4 to -1.0); however, there was no statistically significant difference compared to the control group (using only digital health app). Specifically, participants with diabetes using a hospital-linked digital health app demonstrated a significant decrease in PPG after 12 weeks (-10.9 mg/dL, 95% CI -31.1 to -5.3) compared to those using only a digital health app (P=.006).

CONCLUSIONS

Hospital-linked digital interventions have greatly improved glucose control for diabetes compared with using digital health technology only. These hospital-linked digital health apps have the potential to offer consumers and health care professionals cost-effective support in decreasing glucose levels when used in conjunction with self-monitoring.

Effects of E-health-based interventions on glycemic control for patients with type 2 diabetes: a Bayesian network meta-analysis

The high disease burden of type 2 diabetes seriously affects the quality of life of patients, and with the deep integration of the Internet and healthcare, the application of electronic tools and information technology to has become a trend for disease management. The aim of this study was to evaluate the effectiveness of different forms and durations of E-health interventions in achieving glycemic control in type 2 diabetes patients. PubMed, Embase, Cochrane, and Clinical Trials.gov were searched for randomized controlled trials reporting different forms of E-health intervention for glycemic control in type 2 diabetes patients, including comprehensive measures (CM), smartphone applications (SA), phone calls (PC), short message service (SMS), websites (W), wearable devices (WD), and usual care. The inclusion criteria were as follows: (1) adults (age≥18) with type 2 diabetes mellitus; (2) intervention period ≥1 month; (3) outcome HbA1c (%); and (4) randomized control of E-health based approaches. Cochrane tools were used to assess the risk of bias. R 4.1.2 was used to conduct the Bayesian network meta-analysis. A total of 88 studies with 13,972 type 2 diabetes patients were included. Compared to the usual care group, the SMS-based intervention was superior in reducing HbA1c levels (mean difference (MD)-0.56, 95% confidence interval (CI): -0.82 to -0.31), followed by SA (MD-0.45, 95% CI: -0.61 to -0.30), CM (MD-0.41, 95% CI: -0.57 to -0.25), W (MD-0.39, 95% CI: -0.60 to -0.18) and PC (MD-0.32, 95% CI: -0.50 to -0.14) (p < 0.05). Subgroup analysis revealed that intervention durations of ≤6 months were most effective. All type of E-health based approaches can improve glycemic control in patients with type 2 diabetes. SMS is a high-frequency, low-barrier technology that achieves the best effect in lowering HbA1c, with ≤6 months being the optimal intervention duration.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42022299896.

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

BACKGROUND

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.

Lifestyle medicine for anxiety symptoms: A meta-analysis of randomized controlled trials

BACKGROUND

Lifestyle medicine (LM) is gaining increasing attention as a treatment option for anxiety, but the current state of evidence has not yet been systematically examined.

METHODS

Six electronic databases were systematically searched from inception to February 2022. Randomized controlled trials (RCTs) comparing the effects of multicomponent LM interventions on anxiety symptoms with either care-as-usual, waitlist, no intervention, or attention control group on anxiety symptoms were identified.

RESULTS

A total of 53 RCTs with 18,894 participants were included for qualitative synthesis, in which 45 RCTs with data available were included for meta-analysis. Multicomponent LM intervention was significantly more effective than the control groups in reducing anxiety symptoms at immediate posttreatment (d = 0.19, p < .001) and at short-term follow-up (d = 0.29, p < .001). However, no significant difference at medium-term was found (p = .14), whereas more studies are needed to study the long-term effects. The subgroup analyses suggested that baseline anxiety symptoms was a significant moderator, suggesting that those with moderate level of baseline anxiety symptoms appeared to have greater improvements (d = 0.66, p < .05).

LIMITATIONS

Minimal anxiety symptoms at baseline contributed to the floor effect and influenced the degree of improvement. The included RCTs had a high risk of bias in general with potential publication bias detected.

CONCLUSION

The findings of this meta-analysis provided support for the positive effects of multicomponent LM interventions for anxiety symptoms. Future research is needed to determine the long-term effects of multicimponent LM and the optimal baseline anxiety severity.

Feasibility of a Digital Therapeutic Program for Cancer Patients During Active Treatment: Analysis of Engagement, Retention and Quality of Life (Preprint)

Background

Increasing evidence shows that lifestyle interventions can improve the symptoms, quality of life (QoL), and even overall survival of patients with cancer. Digital therapeutics (DTx) can help implement behavioral modifications and empower patients through education, lifestyle support, and remote symptom monitoring.

Objective

We aimed to test the feasibility of a DTx program for patients with cancer, as measured by engagement, retention, and acceptability. In addition, we explored the effects of the program on cancer-related QoL.

Methods

We conducted a 4-week single-arm trial in Iceland, where DTx was delivered through a smartphone app. The intervention consisted of patient education about mindfulness, sleep, stress, and nutrition; lifestyle coaching; and the completion of daily missions for tracking physical activity and exercise, reporting patient-reported outcomes (PROs), practicing mindfulness, and logging healthy food intake. Information on program engagement and retention, step goal attainment, as well as PROs were collected throughout the study. QoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 at baseline and follow-up.

Results

In total, 30 patients with cancer undergoing active therapy were enrolled, and 29 registered in the app (23 female, 18 with breast cancer; mean age 52.6, SD 11.5 years). Overall, 97% (28/29) of participants were active in 3 of the 4 weeks and completed the pre- and postprogram questionnaires. The weekly active days (median) were 6.8 (IQR 5.8-6.8), and 72% (21/29) of participants were active at least 5 days a week. Users interacted with the app on average 7.7 (SD 1.9) times per day. On week 1, all 29 participants used the step counter and logged an average of 20,306 steps; 21 (72%) participants reached their step goals of at least 3000 steps per day. On week 4, of the 28 active users, 27 (96%) were still logging their steps, with 19 (68%) reaching their step goals. Of the 28 participants who completed the satisfaction questionnaire, 25 (89%) were likely to recommend the program, 23 (82%) said the program helped them deal with the disease, and 24 (86%) said it helped them remember their medication. QoL assessment showed that the average global health status, functioning, and symptom burden remained stable from baseline to follow-up. In all, 50% (14/28) of participants reported less pain, and the average pain score decreased from 31 (SD 20.1) to 22.6 (SD 23.2; P=.16). There was no significant change in PROs on the quality of sleep, energy, and stress levels from the first to the last week.

Conclusions

The high retention, engagement, and acceptability found in this study demonstrate that multidisciplinary DTx is feasible for patients with cancer. A longer, full-scale randomized controlled trial is currently being planned to evaluate the efficacy of the intervention.

A new Digital Health Program for Patients with Inflammatory Bowel Disease: Preliminary Program Evaluation (Preprint)

BACKGROUND

Inflammatory bowel disease (IBD) causes chronic inflammation of the gastrointestinal tract. IBD is characterized by an unpredictable disease course that varies greatly between individuals and alternates between the periods of relapse and remission. A low energy level (fatigue) is a common symptom, whereas stress and reduced sleep quality may be the triggering factors. Therapeutic guidelines call for effective disease assessment, early intervention, and personalized care using a treat-to-target approach, which may be difficult to achieve through typical time- and resource-constrained standard care. Providing patients with a digital health program that incorporates helpful self-management features and patient support to complement standard care may be optimal for improving the disease course.

OBJECTIVE

This study aimed to perform a preliminary program evaluation, analyzing engagement and preliminary effectiveness and the effect on participants' energy levels (fatigue), stress, and sleep quality, of a newly developed 16-week digital health program (SK-311 and SK-321) for patients with IBD.

METHODS

Adults with IBD were recruited to participate in a real-world, live, digital health program via Finnish IBD patient association websites and social media. No inclusion or exclusion criteria were applied for this study. Baseline characteristics were entered by the participants upon sign-up. Platform engagement was measured by tracking the participants' event logs. The outcome measures of stress, energy levels (fatigue), and quality of sleep were reported by participants through the platform.

RESULTS

Of the 444 adults who registered for the digital health program, 205 (46.2%) were included in the intention-to-treat sample. The intention-to-treat participants logged events on average 41 times per week (5.9 times per day) during the weeks in which they were active on the digital platform. More women than men participated in the intervention (126/205, 88.7%). The mean age of the participants was 40.3 (SD 11.5) years, and their mean BMI was 27.9 (SD 6.0) kg/m². In total, 80 people provided the required outcome measures during weeks 12 to 16 (completers). Treatment completion was strongly predicted by the number of active days in week 1. Analysis of the completers (80/205, 39%) showed significant improvements for stress (t₇₉=4.57; P<.001; percentage change=-23.26%) and energy levels (t₇₉=-2.44; P=.017; percentage change=9.48%); however, no significant improvements were observed for quality of sleep (t₇₉=-1.32; P=.19).

CONCLUSIONS

These results support the feasibility of a digital health program for patients with IBD (SK-311 and SK-321) and suggest that treatment completion might have a substantial positive effect on patient-reported stress and energy levels in a real-world setting. These findings are promising and provide initial support for using the Sidekick Health digital health program to supplement standard care for patients with IBD.

Brief Digital Solutions in Behavior Change Interventions for Type 2 Diabetes Mellitus: A Literature Review

INTRODUCTION

With the advent of the COVID-19 pandemic, health systems increasingly look to digital health solutions to provide support for self-management to people with type 2 diabetes (T2D). This review aimed to assess brief digital behavior change solutions (i.e., solutions that require limited engagement or contact) for T2D, including use of behavior change techniques (BCTs) and their impact on self-care and glycemic control.

METHODS

A review was conducted by searching Embase and gray literature using a predefined search strategy to identify randomized controlled trials (RCT) published between January 1, 2015, and March 21, 2021. BCTs were coded using an internationally established BCT taxonomy v1 (BCTTv1).

RESULTS

Out of 1426 articles identified, 10 RCTs were included in qualitative synthesis. Of these, six reported significant improvements in primary outcome(s), including improved patient engagement, glycemic control, self-efficacy, and physical activity. Interventions as short as 12 min were found to be effective, and users' ability to control their preferences was noted as conducive to engagement. Almost three quarters of BCTs targeted by interventions were under the hierarchical clusters of "Feedback and monitoring," "Goals and planning," and "Shaping knowledge." Interventions that targeted fewer BCTs were at least as effective as interventions that were more comprehensive in their goals.

DISCUSSION

Digital behavior change solutions can successfully improve T2D self-care support and outcomes in a variety of populations including patients with low incomes, limited educational attainment, or living in rural areas. Easy-to-use interventions tailored to patient needs may be as effective as lengthy, complex, and more generalized interventions.

CONCLUSIONS

Brief digital solutions can improve clinical and behavioral outcomes while reducing patient burden, fitting more easily in patients' lives and potentially improving usability. As T2D patients increasingly expect access to self-care assistance between face-to-face encounters, digital support tools will play a greater role in effective diabetes management programs.

The Clinical Effects of Type 2 Diabetes Patient Management Using Digital Healthcare Technology: A Systematic Review and Meta-Analysis

The disease control rate is very low (at less than 30%) for diabetes. The use of digital healthcare technology is increasing recently for continuous management in daily life. In this study, a meta-analysis was conducted to evaluate the clinical effects of digital healthcare technology for patients with type 2 diabetes management. For a review of the literature, databases such as PubMed, Embase, and Cochrane Library were searched using Medical Subject Heading (MeSH) terms published up to 9 August 2021. As a result, 2354 articles were identified, and 12 randomized controlled trial articles were finally included. Digital healthcare technology combined management for type 2 diabetes significantly decreased HbA1c (p < 0.00001, standardized mean difference (SMD) = −0.49) and marginally decreased triglyceride, compared with usual care (p = 0.06, SMD = −0.18). However, it did not significantly affect BMI (p = 0.20, SMD = −0.47), total cholesterol (p = 0.13, SMD = −0.19), HLD-C (p = 0.89, SMD = −0.01), LDL-C (p = 0.95, SMD = −0.01), systolic BP (p = 0.83, SMD = 0.03), or diastolic BP (p = 0.23, SMD = 0.65), compared with usual care. These results indicate that digital healthcare technology can improve HbA1c and triglyceride levels of type 2 diabetes patients. Further well-designed randomized controlled clinical trials are needed to confirm the clinical effect of digital healthcare technology.