Telemedicine-assisted structured self-monitoring of blood glucose in management of T2DM results of a randomized clinical trial

Effectiveness of Digital Diabetes Management Technology on Blood Glucose in Patients With Type 2 Diabetes at Home: Systematic Review and Meta-Analysis

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) face elevated morbidity, mortality, and care costs. Digital self-monitoring of blood glucose (SMBG) can automatically upload data to apps, share the data with health care providers, reduce errors, and aid long-term diabetes management.

OBJECTIVE

This study aimed to assess the effectiveness of digital diabetes management techniques based on digital SMBG on blood glucose in patients with T2DM at home.

METHODS

A systematic search was conducted in PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, China Biomedical Literature Database, and Cochrane Library for articles published from the establishment of each database to December 25, 2023. Data were extracted independently by 2 researchers (YX and NX), and the risk of bias in individual trials was rated using the Cochrane risk-of-bias tool. A meta-analysis was conducted using RevMan 5.3 (Cochrane).

RESULTS

Twelve studies were included, involving 1669 participants. The meta-analysis found that in the digital diabetes management group, hemoglobin A1c (mean difference [MD] -0.52%, 95% CI -0.63% to -0.42%; P<.001), fasting blood sugar (MD -0.42, 95% CI -0.65 to -0.19 mmol/L; P<.001), 2-hour postprandial blood sugar (MD -0.64, 95% CI -0.97 to -0.32 mmol/L; P<.001), and BMI (MD -1.55, 95% CI -2.92 to -0.17 kg/m2; P=.03) were each improved compared to the control group.

CONCLUSIONS

Digital diabetes management has been shown to effectively improve blood glucose levels and BMI in individuals with T2DM in home settings. A key feature of successful digital health interventions is the frequent SMBG by patients, supported by dedicated health care professionals who provide timely, personalized, and responsive guidance.

TRIAL REGISTRATION

PROSPERO CRD42024560431; https://tinyurl.com/yfam3nms.

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).

Assessing the Effectiveness of Digital Health Behavior Strategies on Type 2 Diabetes Management: Systematic Review and Network Meta-Analysis

BACKGROUND

Various mobile technologies and digital health interventions (DHIs) have been developed for type 2 diabetes mellitus (T2DM) management. Strategies are crucial for ensuring the effectiveness of DHIs. However, there is currently a lack of categorization and summarization of the strategies used in DHIs for T2DM.

OBJECTIVE

This study aims to (1) identify and categorize the strategies used in DHIs for T2DM management; (2) assess the effectiveness of these DHI strategies; and (3) compare and rank the efficacy of different strategy combinations on glycated hemoglobin A1c (HbA1c) levels, fasting blood glucose (FBG) levels, BMI, and weight loss.

METHODS

Relevant randomized controlled trials (RCTs) were extracted from PubMed, Web of Science, and Scopus databases. Three rounds of screening and selection were conducted. The strategies were identified and categorized based on the principles of behavior change techniques and behavior strategies. The synthesis framework for the assessment of health IT was used to structure the evaluation of the DHI strategies qualitatively. A network meta-analysis was performed to compare the efficacy of different strategy combinations. The data quality was assessed using the Cochrane Risk of Bias tool.

RESULTS

A total of 52 RCTs were included, identifying 63 strategies categorized into 19 strategy themes. The most commonly used strategies were guide, monitor, management, and engagement. Most studies reported positive or mixed outcomes for most indicators based on the synthesis framework for the assessment of health IT. Research involving a medium or high number of strategies was found to be more effective than research involving a low number of strategies. Of 52 RCTs, 27 (52%) were included in the network meta-analysis. The strategy combination of communication, engagement, guide, and management was most effective in reducing HbA1c levels (mean difference [MD] -1.04, 95% CI -1.55 to -0.54), while the strategy combination of guide, management, and monitor was effective in reducing FBG levels (MD -0.96, 95% CI -1.86 to -0.06). The strategy combination of communication, engagement, goal setting, management, and support was most effective for BMI (MD -2.30, 95% CI -3.16 to -1.44) and weight management (MD -6.50, 95% CI -8.82 to -4.18).

CONCLUSIONS

Several DHI strategy combinations were effective in reducing HbA1c levels, FBG levels, BMI, and weight in T2DM management. Health care professionals should be encouraged to apply these promising strategy combinations in DHIs during clinical care. Future research should further explore and optimize the design and implementation of strategies.

TRIAL REGISTRATION

PROSPERO CRD42024544629; https://tinyurl.com/3zp2znxt.

Adherence to Self-Monitoring of Blood Glucose and Its Related Factors Among Type 2 Diabetic Patients Attending Al-Ahsa Primary Health Care Centers in Saudi Arabia

BACKGROUND

Self-monitoring of blood glucose (SMBG) is a crucial component of diabetes management, but adherence remains suboptimal. This study aimed to evaluate adherence to SMBG among type 2 diabetic patients in Al-Ahsa, Saudi Arabia.

METHODS

A cross-sectional study was conducted among 398 type 2 diabetic patients attending primary healthcare centers. Data were collected through face-to-face or virtual interviews and electronic health records. Adherence levels were categorized as low, moderate, and high.

RESULTS

The majority of participants exhibited moderate adherence to SMBG (58.5%), while 27.1% had low adherence, and 14.3% were highly adherent. The use of oral hypoglycemic medications and insulin injections was associated with higher adherence (p<0.001). Comorbidities, physical exercise, diet, frequency of medical visits, and attendance at diabetes education sessions did not significantly influence adherence.

CONCLUSIONS

Suboptimal adherence to SMBG was observed among type 2 diabetic patients in Al-Ahsa. Targeted interventions addressing individual barriers and integrating technology may improve SMBG adherence and diabetes management.

Evaluating the Impact of Telemedicine on Diabetes Management in Rural Communities: A Systematic Review

Telemedicine is the delivery of healthcare services using information and communication technologies to diagnose, treat, and prevent diseases. The COVID-19 pandemic has accelerated the adoption of telemedicine, transforming how healthcare is delivered, especially in remote and underserved areas. Despite its potential, no systematic reviews have been conducted in the last five years to assess the effectiveness of telemedicine for managing diabetes in rural populations. This review addresses this gap by evaluating studies on telemedicine's impact on glycemic control among diabetic patients in these settings. We searched five databases: PubMed, Google Scholar, ClinicalTrials.gov, ScienceDirect, and Science.gov, covering studies published in the last five years. Of the 331 articles identified, 10 met our inclusion criteria: English-language studies from the past five years involving adults in rural areas or comparing rural and urban settings, focusing on telemedicine's impact on glycemic control in diabetic patients. In many studies, the findings revealed that telemedicine interventions integrated into structured programs significantly improved HbA1c levels. Successful implementation requires local infrastructure and consistent patient-provider interactions, although increased healthcare provider workloads may affect sustainability. Telemedicine alone was less effective for patients with complex comorbidities, suggesting that a combined approach with in-person visits may be more effective. This review highlights telemedicine's potential to replace routine in-person visits for diabetes management in rural areas, demonstrating significant improvements in HbA1c levels, medication adherence, and timely care management support. Future research should focus on randomized controlled trials in rural settings, hybrid care models that optimize in-person visit frequency and remote monitoring, and addressing technological challenges such as broadband access and platform usability to ensure sustainable telehealth interventions.

The Impact of the COVID-19 Pandemic on Diabetes Self-Management in Saudi Arabia

The COVID-19 pandemic disrupted healthcare worldwide, potentially impacting disease management. The objective of this study was to assess the self-management behaviors of Saudi patients with diabetes during and after the COVID pandemic period using the Arabic version of the Diabetes Self-Management Questionnaire (DSMQ). A cross-sectional study was conducted in patients aged ≥18 years diagnosed with type 2 diabetes mellitus who had at least one ambulatory clinic visit in each of the specified time frames (Pre-COVID-19: 1 January 2019-21 March 2020; COVID-19 Time frame: 22 March 2020 to 30 April 2021) utilizing the DSMQ questionnaire, with an additional three questions specifically related to their diabetes care during the COVID pandemic. A total of 341 patients participated in the study. The study results revealed that the surveyed patients showed moderately high self-care activities post-COVID-19. Total DSMQ scores were significantly higher in patients aged >60 years versus younger groups (p < 0.05). Scores were significantly lower in patients diagnosed for 1-5 years versus longer durations (p < 0.05). Patients on insulin had higher glucose management sub-scores than oral medication users (p < 0.05). Overall, DSMQ scores were higher than the pre-pandemic Saudi population and Turkish post-pandemic findings. DSMQ results suggest that, while COVID-19 negatively impacted some self-management domains, the Saudi patients surveyed in this study upheld relatively good diabetes control during the pandemic. Further research is warranted on specific barriers to optimize diabetes care during public health crises.