1 / 2024-03-15 10:35:11

Impact of digital therapeutics for the management in adult diabetes patients: a systematic review and meta-analysis

digital therapeutics, diabetes patients, disease management

Background The increasing approval and application of digital therapeutic products in the management of chronic diseases, including diabetes, raise questions about their effectiveness. This study conducted a systematic review and meta-analysis of research reporting on the effectiveness of digital therapeutic interventions in the management of diabetes patients.

Methods In this systematic review and meta-analysis, we conducted searches in Web of Science, Medline, Embase, and the Cochrane Library from the inception of the databases until July 30, 2023. We included randomized controlled trials assessing the effectiveness of digital therapeutic interventions in the health management of individuals with prediabetes (primary prevention) and diagnosed type 1 and type 2 diabetes (secondary prevention). Studies were excluded if the interventions did not align with the definition of digital therapeutics or if the intervention details were not clearly reported. Two reviewers independently assessed and extracted data from the included randomized controlled trials using a standardized template. Our primary outcomes were HbA1c, FBG, BMI, and weight. The Cochrane risk-of-bias (ROB) tool 2.0 was employed to assess the quality of the studies. Heterogeneity was examined using I², Baujat plots, and subgroup analyses to explore the sources of heterogeneity. The protocol for this systematic review and meta-analysis is registered with PROSPERO (CRD42023473743).

Findings Nineteen studies were included in the meta-analysis (n=3264). The intervention of digital therapeutics demonstrated a noteworthy reduction in HbA1c levels among individuals with diabetes (-0.54%, 95% CI -0.72 to -0.36), as well as a decrement in FBG levels (-0.56, 95% CI -0.76 to -0.37) and BMI (-0.84, 95% CI -1.23 to -0.45). Additionally, it played a contributory role in the amelioration of LDL-C (-0.13, 95% CI -0.22 to -0.03) and triglycerides (-0.18, 95% CI -0.34 to -0.02). Subgroup analyses revealed a salutary impact of digital therapeutics on HbA1c improvement in patients with type 2 diabetes mellitus (MD -0.66, 95% CI -0.92 to -0.41). However, this intervention did not elicit a comparable enhancement in HbA1c levels for those with type 1 diabetes mellitus (MD -0.45, 95% CI -0.89 to -0.00). Notably, digital therapeutics did not exhibit a significant effect on weight reduction (-1.07, 95% CI -2.33 to 0.20), systolic and diastolic blood pressure, total cholesterol, and high-density lipoprotein.

Interpretation The intervention of digital therapeutics holds promise in enhancing health management among individuals with diabetes, potentially ameliorating levels of HbA1c, FBG, and BMI. Noteworthy advancements in health management may be achieved through the implementation of digital therapeutics in individuals with type 2 diabetes mellitus (T2DM). However, the certainty regarding its efficacy in the population of individuals with type 1 diabetes mellitus (T1DM) is comparatively lower. Future efforts should be directed towards the personalized development and formulation of interventions, as well as the exploration of the long-term effects of interventions, aiming to strengthen the specificity, comprehensiveness, and effectiveness of digital therapeutics.