Digital Health Services among Patients with Diabetes during the COVID-19 Pandemic: A Scoping Review

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.

Digital Health Interventions in Older Adult Populations Living With Chronic Disease in High-Income Countries: Protocol for a Scoping Review

BACKGROUND

Globally, around 80% percent of adults aged 65 years or older are living with at least 1 chronic disease, and 68% percent have 2 or more chronic diseases. Older adults living with chronic diseases require greater health care services, but these health care services are not always easily accessible. Furthermore, the COVID-19 pandemic has resulted in unprecedented changes in the provision of health care services for older adults. During the COVID-19 pandemic, digital health interventions for chronic disease management were developed out of necessity, but the evidence regarding these and developed interventions is lacking.

OBJECTIVE

In this scoping review, we aim to identify available digital health interventions such as emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms for chronic disease management for older adults in high-income countries.

METHODS

We will follow the Arksey and O'Malley framework to conduct the scoping review. Our full search strategy was developed following a preliminary search on MEDLINE. We will include studies where older adults are at least 65 years of age, living with at least 1 chronic disease (eg, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes), and residing in high-income countries. Digital health interventions will be broadly defined to include emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms.

RESULTS

This scoping review is currently ongoing. As of March 2023, our full search strategy has resulted in a total of 9901 records. We completed the screening of titles and abstracts and obtained 442 abstracts for full-text review. We are aiming to complete our full-text review in October 2024, data extraction in November 2024, and data synthesis in December 2024.

CONCLUSIONS

This scoping review will generate evidence that will contribute to the further development of digital health interventions for future chronic disease management among older adults in high-income countries. More evidence-based research is needed to better understand the feasibility and limitations associated with the use of digital health interventions for this population. These evidence-based findings can then be disseminated to decision-makers and policy makers in other high-income countries.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/49130.

Digital Health Solutions for Community-Based Control of Diabetes During COVID-19 Pandemic: A Scoping Review of Implementation Outcomes

BACKGROUND

The COVID-19 pandemic has added to the pre-existing challenges of diabetes management in many countries. It has accelerated the wider use of digital health solutions which have tremendous potential to improve health outcomes for people with diabetes. However, little is known about the attributes and the implementation of these solutions.

OBJECTIVE

To identify and describe digital health solutions for community-based diabetes management and to highlight their key implementation outcomes.

METHODS

We searched Ovid Medline, CINAHL, Embase, PsycINFO, and Web of Science for relevant articles. A purposive search was also used to identify grey literature. Articles that described digital health solutions that aimed to improve community-based diabetes management were included in this review. We applied a thematic synthesis of evidence to describe the characteristics of digital health solutions, and to summarize their key implementation outcomes.

RESULTS

We included 15 articles that reported digital health solutions that primarily focused on community-based diabetes management. Nine of the 15 innovations involved were mobile applications and/or web-based platforms, and five were based on social media platforms. The majority of the digital health solutions were used for diabetes education and support. High engagement, utilization, and satisfaction rates with digital health solutions were observed. The use of digital health solutions was also associated with improvement in self-management, taking medication, and reduction in glycated hemoglobin (HbA1c) levels.

CONCLUSION

COVID-19 triggered digital health solutions have tremendous potential to improve health outcomes for people with diabetes. Further studies are needed to evaluate the sustainability and scale-up of these solutions.

The impact of telehealth on self-management of patients with type 2 diabetes: A systematic review on interventional studies

BACKGROUND AND AIMS

Self-management is critical to manage the glycemic and metabolic outcomes for patients with diabetes. Telehealth applications are recognized as a potential approach to promote self-management of people with type 2 diabetes. This study aimed to investigate the impact of telehealth on self-management among patients with type 2 diabetes.

METHODS

A systematic review was conducted on several databases, including PubMed, EbscoHost Medline, and Science Direct, with the keywords: Diabetes Mellitus AND Mobile-phone based OR Telemedicine OR Telehealth OR Web-based OR Telenursing AND Self-management. Inclusion criteria were articles with type 2 diabetic respondents, published between 2015 and 2020, open-access articles, and had self-management as outcomes. Hence, qualitative, protocol, or review articles, commentaries, letters to editors, and case study/reports were excluded. The Joanna Briggs Institute critical appraisal tools and Cochrane collaboration's tools were used for assessing risk of bias.

RESULTS

The total of six studies were included in the qualitative synthesis, with five randomized control trials and one cross-sectional study. Telehealth applications were formed as an online or app-based platform with the key features of educational programs, text or voice messages, consultations and counseling, and active participation of the subjects. Besides improving the self-management outcomes, the telehealth also indicated improvements in positive behaviors, attitudes, and the intention of self-management.

CONCLUSION

The study concluded that implementation of telehealth provided positive self-management results among patients with type 2 diabetes. The users need to consider an intensive training, peer or family support, and provision of full support for the patients during the implementation of telehealth.

Digital technologies in the care of people with diabetes during the COVID-19 pandemic: a scoping review

OBJECTIVE

To map evidence on the use of digital technologies in the care of people with diabetes during the COVID-19 pandemic.

METHOD

This is a scoping review, based on the JBI manual, which included scientific articles and gray literature from nine primary and seven secondary databases. Articles were independently assessed by two reviewers. Rayyan® was used to select the studies. The description of study characterization is presented in a table and tables, ending in a narrative synthesis.

RESULTS

A total of 1,964 studies were identified and, after selection, 23 publications remained for analysis. It turned out that telemedicine was used in all studies and remote consultation support technologies included continuous glucose monitoring devices, glucose data analysis software, insulin delivery systems, applications, audio and/or voice communication devices, which facilitated remote diabetes mellitus monitoring and management.

CONCLUSION

Telehealth, monitoring technologies, insulin delivery systems and communication devices were tools used to monitor patients with diabetes during the pandemic.