The quality of evidence is downgraded by study limitations (unclear allocation concealment) and by indirectness (only short-term outcomes reported).
A Cochrane review [Abstract] 1 included 16 randomised controlled trials with 3578 participants with type 2 diabetes (T2DM). The mean age of participants was between 46 to 67 years old, HbA1c was 7.5 to 8.5%, and mean time since diagnosis was 6 to 13 years. The interventions were computer-based software applications that respond to user input and generate tailored content. There were clinic-based brief interventions, Internet-based interventions that could be used from home and mobile phone-based interventions which aimed at to improve cognitive and behavioural skills and emotional self-management through feedback, tailored advice, reinforcement and rewards, patient decision support, goal setting or reminders.The duration of the interventions varied between 1 to 12 months.
Computer-based diabetes self-management interventions did not to affect quality of life (5 studies). It had small effect on glycaemic control measured by HbA1c. The effect size on HbA1c was larger in the mobile phone subgroup. In more than 6 months follow-up there were no significant differences between the groups. Five out of 6 studies reported beneficial changes in diet; four out of 10 studies showed beneficial effects on lipid profile. For exercise the results were mixed (5 studies). None of the studies reported weight loss or coping with depression. One participant withdrew because of anxiety but there were no other documented adverse effects.
| Outcome | Number of participants (trials) | Control (Usual care) | Intervention | Effect size (95 % CI) | |
|---|---|---|---|---|---|
| HbA1c at the end of follow-up | Computer-based self management intervention | 2637(11) | 7.7% | 7.5% | MD -0.2% (-0.4 to -0.1) |
| Mobile phone delivered self management intervention | 280(3) | 7.8% | 7.3% | MD -0.5% (-0.7 to -0.3) | |
A review 2 evaluating a digital intervention among disadvantaged/vulnerable patients with T2DM included 21 studies. Although many digital interventions found within-group HbA1c improvements (16 of 21 studies), only 7 of the 17 studies with a control group found between-group differences in HbA1c. 3 studies found reductions in emergency room visits and hospitalizations.
Date of latest search: 2019-12-21
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