Department of Public & Occupational Health, University of Amsterdam, Amsterdam, Netherlands.
Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana.
JMIR Mhealth Uhealth. 2023 Aug 29;11:e43742. doi: 10.2196/43742.
Mobile health (mHealth) interventions are effective in improving chronic disease management, mainly in high-income countries. However, less is known about the efficacy of mHealth interventions for the reduction of cardiovascular risk factors, including for hypertension and diabetes, which are rapidly increasing in low- and middle-income countries.
This study aimed to assess the efficacy of mHealth interventions for diabetes and hypertension management in Africa.
We searched PubMed, Cochrane Library, Google Scholar, African Journals Online, and Web of Science for relevant studies published from inception to July 2022. The main outcomes of interest were changes in hemoglobin A1c (HbA1c), systolic blood pressure, and diastolic blood pressure. The random or fixed effect model was used for the meta-analysis, and the I2 statistic was used to gauge study heterogeneity. Z tests and P values were used to evaluate the effect of mHealth interventions on HbA1c and blood pressure levels.
This review included 7 studies (randomized controlled trials) with a total of 2249 participants. Two studies assessed the effect of mHealth on glycemic control, and 5 studies assessed the effect of mHealth on blood pressure control. The use of mHealth interventions was not associated with significant reductions in HbA1c levels (weighted mean difference [WMD] 0.20, 95% CI -0.40 to 0.80; P=.51) among patients with diabetes and systolic blood pressure (WMD -1.39, 95% CI -4.46 to 1.68; P=.37) and diastolic blood pressure (WMD 0.36, 95% CI -1.37 to 2.05; P=.69) among patients with hypertension. After conducting sensitivity analyses using the leave-one-out method, the Kingue et al study had an impact on the intervention, resulting in a 2 mm Hg reduction in systolic blood pressure (WMD -2.22, 95% CI -3.94 to -0.60; P=.01) but was nonsignificant for diastolic blood pressure and HbA1c levels after omitting the study.
Our review provided no conclusive evidence for the effectiveness of mHealth interventions in reducing blood pressure and glycemic control in Africa among persons with diabetes and hypertension. To confirm these findings, larger randomized controlled trials are required.
移动医疗（mHealth）干预措施在改善慢性病管理方面非常有效，主要在高收入国家。然而，对于 mHealth 干预措施在降低心血管风险因素方面的效果，包括在高血压和糖尿病方面的效果，我们知之甚少，而这些疾病在中低收入国家正在迅速增加。
本研究旨在评估 mHealth 干预措施在非洲地区用于糖尿病和高血压管理的疗效。
我们在 PubMed、Cochrane 图书馆、谷歌学术、非洲期刊在线和 Web of Science 上搜索了从成立到 2022 年 7 月发表的相关研究。主要观察指标是血红蛋白 A1c（HbA1c）、收缩压和舒张压的变化。采用随机或固定效应模型进行荟萃分析，并采用 I2 统计量评估研究异质性。Z 检验和 P 值用于评估 mHealth 干预措施对 HbA1c 和血压水平的影响。
本综述共纳入 7 项研究（随机对照试验），共计 2249 名参与者。其中 2 项研究评估了 mHealth 对血糖控制的影响，5 项研究评估了 mHealth 对血压控制的影响。使用 mHealth 干预措施并不能显著降低糖尿病患者的 HbA1c 水平（加权均数差 [WMD] 0.20，95%置信区间 [CI] -0.40 至 0.80；P=.51），也不能显著降低高血压患者的收缩压（WMD -1.39，95% CI -4.46 至 1.68；P=.37）和舒张压（WMD 0.36，95% CI -1.37 至 2.05；P=.69）。采用逐一剔除法进行敏感性分析后，Kingue 等人的研究结果对干预措施产生了影响，导致收缩压降低 2mmHg（WMD -2.22，95% CI -3.94 至 -0.60；P=.01），但剔除该研究后，舒张压和 HbA1c 水平的变化无统计学意义。
我们的综述结果没有提供确凿的证据表明 mHealth 干预措施在非洲糖尿病和高血压患者中降低血压和血糖控制方面的有效性。为了证实这些发现，需要进行更大规模的随机对照试验。
