| 摘要: | Background:
Diabetes Self-Management Education and Support (DSMES) improves outcomes and reduce costs for Diabetes. In the technology era, digital health has delivered DSMES with varying success. Additionally, continuous digital innovations require up-to-date evidence.
Objective:
To describe digital health-led DSMES interventions and assess their effectiveness in improving glycemic control (glycosylated hemoglobin (HbA1c)), Diabetes knowledge and health-related quality of life (HrQoL) of Type 1 (T1DM) and Type 2 (T2DM) Diabetes compared to usual care in the past 10 years.
Design: Systematic Review and Meta-Analysis
Method:
The following databases were searched: PubMed, EMBASE, Cochrane library, Web of Science and Scopus for articles published between January, 2010 to August, 2019. We included randomized control trials (RCTs) with digital health-led DSMES interventions for T1DM and T2DM. Outcomes were change in HbA1c, diabetes knowledge and HrQoL. Protocol was registered on PROSPERO # CRD42019139884. We used Cochrane Risk of Bias (ROB) 2.0 tool to assess bias and GRADEpro for confidence of evidence. Analysis involved qualitative synthesis, overall meta-, subgroup analyses and meta-regression.
Results:
From 4,286 articles, 39 studies were included with a total of 6, 861 participants. 79.5% of participants had T2DM. 46.82% of participants were female. Most studies were conducted in North America, Asia and Europe. Meta-analysis revealed that digital-led DSMES significantly reduced HbA1c with difference in means of (MD) -0.480% (-0.661, -0.299), I2 75% (6 months), and -0.457% (-0.761, -0.151), I2 81% (12 months) compared to usual care. Further analysis showed better glycemic control with use of mobile apps and patient portals. The review revealed non-significant improvement of HrQoL Hedges’ g 0.183 (-0.039, 0.405), I2 0% (6 months), 0.153 (-0.060, 0.366), I2 0% (12 months) but significant improvement for Diabetes Knowledge Hedges’ g 1.003 (0.068, 1.938), I2 87% (3 months) compared to usual care.
Conclusion:
The review offers evidence that digital health-led DSMES are effective in reducing HbA1c at 6 and 12 months as compared to usual care, though less pronounced for T1DM populations. Evidence shows small non-significant improvements in participants’ HrQoL at 6 and 12 months but significant improvement in Diabetes Knowledge at 3 months. Intervention effect was more impressive if delivered through mobile apps or patient portals. Further research is required to investigate impact of digital health-led DSMES in newly diagnosed Diabetes patients as well as Diabetes patients living in Sub-Saharan African countries. |
