Effects of multimodal mobile health interventions on cardiovascular risk factor management in patients with diabetes: a systematic review and meta-analysis.

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• A robust systematic review and meta-analysis was conducted.

• Findings demonstrated that multimodal mHealth interventions are effective in improving cardiovascular disease risk factors in people living with diabetes compared with standard care.

• Authors concluded that multimodal mHealth interventions are a valuable addition to optimise standard diabetes care in the community.

Introduction

• Mobile health (mHealth) interventions are promising approaches for managing cardiovascular disease (CVD) risk factors.

• Multimodal interventions are defined as incorporating at least three components, e.g. mobile apps, remote biomarker monitoring, wearable devices, video consultations and/or SMS reminders.

• This systematic review and meta-analysis evaluated multimodal mHealth interventions on managing CVD risk factors in adults living with diabetes.

Methods

• A systematic literature search identified randomised, controlled trials (RCTs) in adults living with diabetes (type unspecified) that compared multimodal mHealth interventions (duration: at least 3 months) with standard care.

• The authors searched MEDLINE, Web of Science, Embase, Cochrane Library, and CINAHL for articles published between January 2010 and December 2024.

• Pooled effect sizes, considering heterogeneity across studies, were expressed as weighted mean differences, or odds ratios (OR) for categorical variables.

• Meta-regression was conducted for haemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), total cholesterol, and physical activity participation against covariates (risk of bias, intervention duration, age, male gender, geographical region).

Results

• The search identified 17 RCTs with 2946 participants.

• Multimodal mHealth interventions significantly reduced HbA1c (−0.38%; p<0.0001), fasting glucose (−14.1 mg/dL; p<0.0001), systolic blood pressure (−1.30 mmHg; p=0.0021), LDL-C (−6.07 mg/dL; p=0.0004), total cholesterol (−5.40 mg/dL; p=0.0177) and triglycerides (−6.50 mg/dL; p=0.0383), and increased physical activity participation (OR=3.41; p=0.0259) versus standard care.

• Body mass index, diastolic blood pressure, high-density lipoprotein cholesterol and smoking cessation did not differ between groups.

• Longer interventions did not appear to produce larger HbA1c reductions.

Conclusion

• Multimodal mHealth interventions are effective strategies for improving several key CVD risk factors, including glycaemic control, blood pressure, lipid profiles and physical activity levels in people living with diabetes.

Multimodal mHealth interventions, including mobile apps, remote biomarker monitoring, wearable devices, video consultations and/or SMS reminders can be low cost and used at scale, and evidence suggests they are a valuable addition to conventional diabetes care.

Since multimodal mHealth interventions typically assume a certain level of digital skills and literacy, the authors acknowledge these findings may not be generalisable to all groups, such as older adults and those with lower literacy. They recommended that equitable access is a focus for future mHealth interventions, such as the inclusion of voice-based apps and simplified wearables, to “bridge the digital divide”.