Telehealth delivery of motivational interviewing for diabetes management: A systematic review of randomized controlled trials

Objectives: The objective of this systematic review was to explore and report the evidence and gaps in the literature for randomized controlled trials (RCTs) studying the effects of motivational interviewing (MI)based telehealth interventions on outcomes among persons with diabetes (PWD) or prediabetes. Methods: Following a modified Cochrane approach, we searched Pubmed, CENTRAL, CINAHL, PsycINFO, and Clinicaltrials.gov. Included studies were RCTs published in English before March 25, 2021 evaluating MIbased telehealth on outcomes for adults with diabetes or prediabetes. Results: A total of 21 retained articles captured results for 6436 PWD. Among the most commonly investigated outcomes, 60% of articles documented A1C reductions (ranging from < 1% to > 3%), 56% documented systolic blood pressure reductions, 57% documented diabetes self-efficacy/empowerment improvements, and 40% documented physical activity improvements. Conversely, diastolic blood pressure, lipid panels, body mass index, depressive symptoms, and quality of life were frequently measured outcomes, where MI-based telehealth yielded minor effects (< 30% of articles demonstrating improvements). Conclusions: MI-based telehealth seems most effective for improving A1C, systolic blood pressure, diabetes self-efficacy, and physical activity behaviors. Variability in outcome assessment and intervention heterogeneity were key challenges impeding comparisons across retained articles. Practice implications: MI-based telehealth interventions demonstrate promising results for improving outcomes in PWD.