Digital Interventions for Self-Management of Type 2 Diabetes Mellitus: Systematic Literature Review and Meta-Analysis

Background: The proliferation of digital technology has the potential to transform diabetes management. One of the criticalaspects of modern diabetes management remains the achievement of glycemic targets to avoid acute and long-term complications. Objective: This study aims to describe the landscape of evidence pertaining to the relative effectiveness or efficacy and safetyof various digital interventions for the self-management of type 2 diabetes mellitus (T2DM), with a primary focus on reducingglycated hemoglobin A1c(HbA1c) levels. Methods: A systematic literature review (SLR) was conducted by searching Embase, MEDLINE, and CENTRAL on April 5,2022. Study selection, data extraction, and quality assessment were performed by 2 independent reviewers. Eligibility criteriafor the SLR included randomized controlled trials (RCTs) and comparative observational studies evaluating interventions containingboth human (eg, coaching) and digital components (eg, glucose meter) in adult patients with T2DM. The primary meta-analysiswas restricted to studies that reported laboratory-measured HbA1c. In secondary analyses, meta-regression was performed withthe intensity of coaching in the digital intervention as a categorical covariate. Results: In total, 28 studies were included in this analysis. Most studies (23/28, 82%) used the reduction of HbA1clevels as theprimary end point, either directly or as a part of a multicomponent outcome. In total, 21 studies reported statistically significantresults with this primary end point. When stratified into 3 intervention categories by the intensity of the intervention supportingthe digital health technology (analyzing all 28 studies), the success rate appeared to be proportional to the coaching intensity (ie,higher-intensity studies reported higher success rates). When the analysis was restricted to RCTs using the comparative improvementof HbA1clevels, the effectiveness of the interventions was less clear. Only half (12/23, 52%) of the included RCTs reportedstatistically significant results. The meta-analyses were broadly aligned with the results of the SLR. The primary analysis estimateda greater reduction in HbA1cassociated with digital interventions compared with usual care (-0.31%, 95% CI -0.45% to -0.16%;P<.001). Meta-regression estimated reductions of -0.45% (95% CI -0.81% to -0.09%; P=.02), -0.29% (95% CI -0.48% to-0.11%; P=.003), and -0.28% (95% CI -0.65% to 0.09%; P=.20) associated with high-, medium-, and low-intensity interventions,respectively. Conclusions: These findings suggest that reducing HbA1clevels in individuals with T2DM with the help of digital interventionsis feasible, effective, and acceptable. One common feature of effective digital health interventions was the availability of timelyand responsive personalized coaching by a dedicated health care professional