Step counter use in type 2 diabetes: a meta-analysis of randomized controlled trials
Open accessAbstract
BACKGROUND: While step counter use has become popular among type 2 diabetes (T2D) patients, its effectiveness in increasing physical activity (PA) and improving glycemic control has been poorly defined. The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the association of step counter use with PA and glycemic control in T2D patients. METHODS: Articles were identified by searches of PubMed, Web of Science and Cochrane Library from January 1994 to June 2013. RCTs in the English language were included, if they had assessed the effectiveness of step counters as motivating and monitoring tools in T2D patients, with reported changes in steps per day (steps/d) or glycosylated hemoglobin A1c (HbA1c), or both. Data were independently collected by 2 authors and overall estimates were made by a random-effects model. RESULTS: Of the 551 articles retrieved, 11 RCTs were included. Step counter use significantly increased PA by 1,822 steps/d (7 studies, 861 participants; 95% confidence interval (CI): 751 to 2,894 steps/d) in patients with T2D. Step counter use with a PA goal showed a bigger increase in PA (weighted mean difference (WMD) 3,200 steps/d, 95% CI: 2,053 to 4,347 steps/d) than without (WMD 598 steps/d, 95% CI: -65 to 1,260 steps/d). Further subgroup analysis suggested step counter use with a self-set PA goal (WMD 2,816 steps/d, 95% CI: 1,288 to 4,344 steps/d) made no difference in increasing PA from a 10,000 steps/d goal (WMD 3,820 steps/d, 95% CI: 2,702 to 4,938 steps/d). However, no significant HbA1c change was observed by step counter use (10 studies, 1,423 participants; WMD 0.02%, 95% CI: -0.08% to 0.13%), either with (WMD 0.04%, 95% CI: -0.21% to 0.30%) or without a PA goal (WMD 0.01%, 95% CI: -0.10% to 0.13%). CONCLUSIONS: Step counter use is associated with a significant increase in PA in patients with T2D. However, evidence regarding its effect in improving glycemic control remains insufficient. TRIAL REGISTRATION: PROSPERO CRD42013005236.
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For step count mean differences, Ringeval and colleagues of consumer activity-tracker-based interventions reported an increase of 951 daily steps (95% CI 476 to 1425), whereas two meta-analyses of pedometer-based interventions reported increases of 1822 (95% CI 751 to 2894) to 2491 (1098 to 3885) daily steps.
“Three other metaanalyses provided mean-difference data for step count; the meta-analysis by Ringeval and colleagues 63 of consumer activity-tracker-based interventions reported an increase of 951 daily steps (95% CI 476 to 1425), whereas two meta-analyses of pedometer-based interventions reported increases of 1822 (95% CI 751 to 2894) 60 to 2491 (1098 to 3885) 10 daily steps (appendix p 35).”
From Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses. (2022) · cites this paper as [60]
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Experimental — accuracy not yet measuredWearable activity trackers significantly increased daily step counts in patients with T2D (p < 0.05), with low evidence certainty.
“Three reviews evaluated the effect of wearable activity trackers on daily step counts in patients with T2D [42, 43, 45], all reporting statistically significant increases in the intervention group (p < 0.05) but with low evidence certainty.”
From Effectiveness of Wearable Devices for Diabetes Management: An Overview of Systematic Reviews and Meta‐Analyses (2026) · cites this paper as [42]
The Results > Effect on PA section reports a significant increase of 1,822 steps per day in patients with T2D (95% CI: 751 to 2,894), supporting the step-count finding and statistical significance. The Discussion > Strengths and limitations section notes high heterogeneity and possible bias, but our copy does not assign the finding a low evidence-certainty rating. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPedometers and smart wristbands effectively increase daily step counts and physical activity levels, contributing to improvements in lipid profiles and blood pressure.
“In exercise management, pedometers and smart wristbands effectively increase daily step counts and physical activity levels, contributing to improvements in lipid profiles and blood pressure [42–45].”
From Effectiveness of Wearable Devices for Diabetes Management: An Overview of Systematic Reviews and Meta‐Analyses (2026) · cites this paper as [42]
The Results (Effect on PA; page unavailable) report that step-counter use increased physical activity by 1,822 steps per day in people with type 2 diabetes. The Background mentions evidence of improved blood pressure and lipid profiles, but the Discussion (Strengths and limitations; page unavailable) says this meta-analysis did not assess those outcomes. The cited analysis also does not establish effectiveness for smart wristbands specifically. (LLM, conf=0.88)
Experimental — accuracy not yet measuredWearable-based exercise management interventions (e.g., pedometers with daily step targets) effectively improve physical activity and lipid profiles.
“In exercise management, wearable‐based exercise management interventions (e.g., pedometers with daily step targets) effectively improve physical activity and lipid profiles [42, 43, 45].”
From Effectiveness of Wearable Devices for Diabetes Management: An Overview of Systematic Reviews and Meta‐Analyses (2026) · cites this paper as [42]
The Results (Effect on PA; no page given) report that step counters increased physical activity in people with type 2 diabetes, particularly when paired with a step goal. The Background says earlier evidence suggests improved lipid profiles, but the Discussion (Strengths and limitations; no page given) states that this meta-analysis did not assess lipids. The claim presents lipid improvement more definitively than this source establishes. (LLM, conf=0.84)
Experimental — accuracy not yet measuredRecent reviews have shown that CWATs have potential to increase physical activity.
“Although recent reviews have shown that CWATs have potential to increase physical activity, they included only one type of chronic disease [19, 20] or solely pedometers [14, 21].”
Recent reviews of CWATs included only one type of chronic disease or solely pedometers.
“Although recent reviews have shown that CWATs have potential to increase physical activity, they included only one type of chronic disease [19, 20] or solely pedometers [14, 21].”
Other meta-analyses have shown increased physical activity among outpatient adults (+2500 steps/day) and patients with T2DM (+1822-2042 steps/day).
“These results are consistent with findings from other meta-analyses showing an increased physical activity among outpatient adults (+ 2500 steps/day) [14] and patients with T2DM (+ 1822–2042 steps/day) [21, 22].”
Protocol and registration information was reported in only three included studies.
“Particularly, the protocol and registration information were reported in only three studies [37, 41, 42] and the data accessibility was inadequately reported, with only two studies specifying data retrieval pathways [25, 38].”
From Effectiveness of Wearable Devices for Diabetes Management: An Overview of Systematic Reviews and Meta‐Analyses (2026) · cites this paper as [42]
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References 46 · Cited by 106
- Authors
- Qiu, S., Cai, X., Chen, X., Yang, B., & Sun, Z.
- Affiliations
- Universität Ulm (DE)
- Zhongda Hospital Southeast University (CN)
- Corresponding author
- Sun, Zilin
- Venue
- BMC Medicine
- Published
- 2014-02-27
- Volume
- 12
- Issue
- 1
- Pages
- 36-36
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC4016223
- OpenAlex
- W2044333539
- Cited by
- 106
- References
- 46
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 6 · 2023: 7 · 2022: 12 · 2021: 23 · 2020: 13 · 2019: 6 · 2018: 9 · 2017: 10 · 2016: 10 · 2015: 4 · 2014: 2
- FWCI
- 1.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Natural Science Foundation of Jiangsu Province
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- step counter, type 2 diabetes, physical activity, glycemic control, HbA1c, physical activity goals, self-monitoring, motivation, step count, 10,000 steps goal, diabetes self-management education, glycemic variability, diabetes complications
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 2, Humans, Motor Activity, Randomized Controlled Trials as Topic, Monitoring, Ambulatory
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