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Cited by 156Mobile Health and mHealth ApplicationsDiabetes Management and EducationDigital Mental Health Interventions

Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials

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Moschonis, George, Siopis, George, Jung, Jenny, Eweka, Evette, Willems, Ruben, Kwasnicka, Dominika, Asare, Bernard Yeboah-Asiamah, Kodithuwakku, Vimarsha +112 more·2023·The Lancet Digital Health
DOI 10.1016/s2589-7500(22)00233-3
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Abstract

Background Digital health interventions have shown promising results for the management of type 2 diabetes, but a comparison of the effectiveness and implementation of the different modes is not currently available.Therefore, this study aimed to compare the effectiveness of SMS, smartphone application, and website-based interventions on improving glycaemia in adults with type 2 diabetes and report on their reach, uptake, and feasibility.Methods In this systematic review and meta-analysis, we searched CINAHL, Cochrane Central, Embase, MEDLINE, and PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) that examined the effectiveness of digital health interventions in reducing glycated haemoglobin A 1c (HbA 1c ) in adults with type 2 diabetes, published in English from Jan 1, 2009.Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines.The primary endpoint assessed was the change in the mean (and 95% CI) plasma concentration of HbA 1c at 3 months or more.Cochrane risk of bias 2 was used to assess risk of bias.Data on reach, uptake, and feasibility were summarised narratively and data on HbA 1c reduction were synthesised in a meta-analysis.Grading of Recommendations, Assessment, Development, and Evaluation criteria was used to evaluate the level of evidence.The study was registered with PROSPERO, CRD42021247845.Findings Of the 3236 records identified, 56 RCTs from 24 regions (n=11 486 participants), were included in the narrative synthesis, and 26 studies (n=4546 participants) in the meta-analysis.20 studies used SMS as the primary mode of delivery of the digital health intervention, 25 used smartphone applications, and 11 implemented interventions via websites.Smartphone application interventions reported higher reach compared with SMS and website-based interventions, but website-based interventions reported higher uptake compared with SMS and smartphone application interventions.Effective interventions, in general, included people with greater severity of their condition at baseline (ie, higher HbA 1c ) and administration of a higher dose intensity of the intervention, such as more frequent use of smartphone applications.Overall, digital health intervention group participants had a -0•30 (95% CI -0•42 to -0•19) percentage point greater reduction in HbA 1c , compared with control group participants.The difference in HbA 1c reduction between groups was statistically significant when interventions were delivered through smartphone applications (-0•42% [-0•63 to -0•20]) and via SMS (-0•37% [-0•57 to -0•17]), but not when delivered via websites (-0•09% [-0•64 to 0•46]).Due to the considerable heterogeneity between included studies, the level of evidence was moderate overall.Interpretation Smartphone application and SMS interventions, but not website-based interventions, were associated with better glycaemic control.However, the studies' heterogeneity should be recognised.Considering that both smartphone application and SMS interventions are effective for diabetes management, clinicians should consider factors such as reach, uptake, patient preference, and context of the intervention when deciding on the mode of delivery of the intervention.Nine in ten people worldwide own a feature phone and can receive SMS and four in five people have access to a smartphone, with numerous smartphone applications being available for diabetes management.Clinicians should familiarise themselves with this modality of programme delivery and encourage people with type 2 diabetes to use evidence-based applications for improving their self-management of diabetes.Future research needs to describe in detail the mediators and moderators of the effectiveness and implementation of SMS and smartphone application interventions, such as the optimal dose, frequency, timing, user interface, and communication mode to both further improve their effectiveness and to increase their reach, uptake, and feasibility.

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  • People with T2D who use digital apps had a 0.30% greater reduction in HbA1c when compared to a control group.

    “A systematic review and meta-analysis of randomised controlled trials has shown that people with T2D who use digital apps had a 0.30% greater reduction in HbA1c when compared to a control group17.”

    From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [17]

    The Website section reports a 0.30-percentage-point greater HbA1c reduction for digital health interventions overall versus usual care. That pooled estimate includes SMS, smartphone apps, and websites; the smartphone-app subgroup had a 0.42-percentage-point greater reduction, so the 0.30 figure is not specific to app users. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

  • Prior meta-analyses excluded remote consultation and monitoring functionalities and focused only on T2DM patients with hypertension, comprising only 4 studies spanning 2009-2022.

    “prior meta-analyses excluded remote consultation and monitoring functionalities and focused only on T2DM patients with hypertension (comprising only 4 studies spanning 2009–2022)”

    From The effectiveness of digital health intervention on glycemic control and physical activity in patients with type 2 diabetes: a systematic review and meta-analysis (2025) · cites this paper as [39]

    The Search strategy and selection criteria section (page not available) says this review excluded telecounselling and telemonitoring and considered studies published from 2009 to May 25, 2022. But the Results section (page not available) reports 56 type 2 diabetes studies in the systematic review and 26 in its meta-analysis, not four; studies focused exclusively on hypertension were set aside for a separate manuscript. These passages describe this review, not the alleged limitations of prior meta-analyses. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • Some studies concluded that web-based interventions do not effectively improve blood glucose in T2DM patients.

    “some studies concluded that web-based interventions do not effectively improve blood glucose in T2DM patients (39)”

    From The effectiveness of digital health intervention on glycemic control and physical activity in patients with type 2 diabetes: a systematic review and meta-analysis (2025) · cites this paper as [39]

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Research works printed but not linked: 2

  1. Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. J Diabetes Sci Technol 2017; 11: 1015-27.
  2. Zhang L, He X, Shen Y, et al. A randomized controlled trial of a smart phone-based diabetes management application to improve blood glucose control in Chinese people with diabetes. J Med Internet Res 2019; 9: 140.

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Authors
Moschonis, G., Siopis, G., Jung, J., Eweka, E., Willems, R., Kwasnicka, D., Asare, B. Y.-A., Kodithuwakku, V., Verhaeghe, N., Vedanthan, R., Annemans, L., Oldenburg, B., Manios, Y., Oldenburg, B., Kwasnicka, D., Gong, E., Jung, J., Asare, B. Y.-A., Kodithuwakku, V., Votis, K., Segkouli, S., Triantafyllidis, A., Kyparissis, O., Paliokas, I., Polychroniou, E., Annemans, L., Verhaeghe, N., Willems, R., De Craemer, D., Manios, Y., Anastasiou, K., Tserpes, K., Mavrogianni, C., Karaglani, E., Kalogerakou, E., Maragkoudaki, M., Ntzouvani, A., Kontochristopoulou, K., Dupont, S., Dupont, E., Dauzon, L., Roskams, M., Lennox-Chhugani, N., Perrin, M., Day, N. D., Ferrer, G., Snook, O., Aldasoro, E., Gil-Salmerón, A., Peiró, P. G., Curran, D., Lyne, F., Curreri, N. A., Moschonis, G., Siopis, G., Pierantozzi, N., D'Antonio, C., Vespasiani, G., Almonti, T., Skouteris, H., Taylor, T., Savaglio, M., Makrilakis, K., Stergiou, G., Liatis, S., Karamanakos, G., Koliaki, C., Kollias, A., Zikou, E., Dimosthenopoulos, H., Vedanthan, R., Huang, K.-Y., Adhikari, S., Qian, K., Dickhaus, J., Carney, K., Eweka, E., Sahito, F., Pavlovic, D., Djokic, D., Sahito, A., Battalova, G., Seghieri, C., Nutti, S., Vanieri, M., Belle, N., Bertarelli, G., Cantarelli, P., Ferre, F., Noci, A., Tortu, C., Bozzi, N., Ferrari, D., Borelli, R., Iotova, V., Yotov, Y., Usheva, N., Kozhuharova, A., Russeva, V., Marinova, V., Koleva, S., Atanasova, V., Stefanova, T., Tsochev, K., Aznar, L. M., Botaya, R. M., Lozano, G. B., De Miguel-Etayo, P., Gonzalez-Gil, E. M., Miguel-Berges, M. L., Pérez, S., Blázquez, B. O., Giménez-Legarre, N., Toti, F., Prifti, S., Bombaj, B., Doracaj, D., Laze, O., Lapardhaja, A., & Bruka, L.
Affiliations
  • Centre for Research and Technology Hellas (GR)
  • Ghent University (BE)
  • International Diabetes Federation (BE)
  • International Foundation for Integrated Care (GB)
  • La Trobe University (AU)
  • National and Kapodistrian University of Athens (GR)
  • Monash University (AU)
  • Baker Heart and Diabetes Institute (AU)
  • Deakin University (AU)
  • York University (US)
  • Medical University of Varna (BG)
  • Universidad de Zaragoza (ES)
  • University of Medicine Tirana (AL)
ORCID
Venue
The Lancet Digital Health
Publisher
Elsevier BV
Published
2023-03
Volume
5
Issue
3
Pages
e125-e143
ISSN
2589-7500 (ISSN-L)
DOI
10.1016/s2589-7500(22)00233-3
OpenAlex
W4321488362
Cited by
149
References
103
Citations by year
2026: 51 · 2025: 50 · 2024: 38 · 2023: 10
FWCI
7.53
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Digital Health (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by)
  • ARCA (Università Ca' Foscari Venezia) (submittedVersion, cc-by)
  • Lirias (KU Leuven) (submittedVersion, cc-by)
  • Deakin Research Online (Deakin University) (cc-by)
Funders
  • Deakin University
  • European Commission
  • National Health and Medical Research Council (APP2007006)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
type 2 diabetes, digital health interventions, HbA1c, HbA1c reduction, text messaging intervention, mobile application, REACH regulation, intervention uptake, feasibility, diabetes self-management, dose intensity, dose-response relationship, GRADE evidence grading
MeSH terms
Smartphone, Adult, Diabetes Mellitus, Type 2, Feasibility Studies, Humans, Randomized Controlled Trials as Topic, Mobile Applications

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