Wang Yachen, Chai Xin, Wang Yueqing, Yin Xuejun, Huang Xinying, Gong Qiuhong, Zhang Juan, Shao Ruitai, Li Guangwei
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
The George Institute for Global Health, University of New South Wales, Newtown, Australia.
J Med Internet Res. 2025 Jan 29;27:e63975. doi: 10.2196/63975.
Lifestyle interventions have been acknowledged as effective strategies for preventing type 2 diabetes mellitus (T2DM). However, the accessibility of conventional face-to-face interventions is often limited. Digital health intervention has been suggested as a potential solution to overcome the limitation. Despite this, there remains a significant gap in understanding the effectiveness of digital health for individuals with prediabetes, particularly in reducing T2DM incidence and reverting to normoglycemia.
This study aimed to assess the effectiveness of different intervention modes of digital health, face-to-face, and blended interventions, particularly the benefits of digital health intervention, in reducing T2DM incidence and facilitating the reversion to normoglycemia in adults with prediabetes compared to the usual care.
We conducted a comprehensive search in 9 electronic databases, namely MEDLINE, Embase, ACP Journal Club, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Clinical Answers, Cochrane Methodology Register, Health Technology Assessment, and NHS Economic Evaluation Database through Ovid, from the inception to October 2024. This review included randomized controlled trials (RCTs) that studied the effectiveness of lifestyle interventions in adults with prediabetes. The overall intervention effect was synthesized using a random-effects model. The I² statistic was used to assess heterogeneity across the RCTs. We performed a subgroup analysis to explore the effectiveness of digital health, face-to-face, and blended interventions compared with the control group, which received usual care.
From an initial 7868 records retrieved from 9 databases, we identified 54 articles from 31 RCTs. Our analysis showed that face-to-face interventions demonstrated a significant 46% risk reduction in T2DM incidence (risk ratio [RR] 0.54, 95% CI 0.47-0.63; I²=43%; P<.001), and a 46% increase in the reversion to normoglycemia (RR 1.46, 95% CI 1.11-1.91; I²=82%; P=.006), when compared with the control group. On the other hand, digital health interventions, compared with the control group, were associated with a 12% risk reduction in T2DM incidence (RR 0.88, 95% CI 0.77-1.01; I²=0.6%; P=.06). Moreover, the blended interventions combining digital and face-to-face interventions suggested a 37% risk reduction in T2DM incidence (RR 0.63, 95% CI 0.49-0.81;I²<0.01%; P<.001) and an 87% increase in the reversion to normoglycemia (RR 1.87, 95% CI 1.30-2.69; I²=23%; P=.001). However, no significant effect on the reversal of prediabetes to normoglycemia was observed from the digital health interventions.
Face-to-face interventions have consistently demonstrated promising effectiveness in both reductions in T2DM incidence and reversion to normoglycemia in adults with prediabetes. However, the effectiveness of digital health interventions in these areas has not been sufficiently proven. Given these results, further research is required to provide more definitive evidence of digital health and blended interventions in T2DM prevention in the future.
PROSPERO CRD42023414313; https://tinyurl.com/55ac4j4n.
生活方式干预已被公认为预防2型糖尿病（T2DM）的有效策略。然而，传统面对面干预的可及性往往有限。数字健康干预被认为是克服这一限制的潜在解决方案。尽管如此，对于糖尿病前期个体，在理解数字健康干预的有效性方面，尤其是在降低T2DM发病率和恢复正常血糖方面，仍存在重大差距。
本研究旨在评估数字健康、面对面和混合干预等不同干预模式的有效性，特别是数字健康干预在降低糖尿病前期成年人T2DM发病率和促进恢复正常血糖方面相对于常规护理的益处。
我们通过Ovid在9个电子数据库中进行了全面检索，这些数据库分别是MEDLINE、Embase、ACP Journal Club、Cochrane对照试验中央注册库、Cochrane系统评价数据库、Cochrane临床答案、Cochrane方法学注册库、卫生技术评估和NHS经济评估数据库，检索时间从建库至2024年10月。本综述纳入了研究生活方式干预对糖尿病前期成年人有效性的随机对照试验（RCT）。使用随机效应模型综合总体干预效果。I²统计量用于评估各RCT之间的异质性。我们进行了亚组分析，以探讨数字健康、面对面和混合干预与接受常规护理的对照组相比的有效性。
从9个数据库检索到的7868条初始记录中，我们从31项RCT中确定了54篇文章。我们的分析表明，与对照组相比，面对面干预使T2DM发病率显著降低46%（风险比[RR]0.54，95%置信区间0.47 - 0.63；I² = 43%；P <.001），恢复正常血糖的比例增加46%（RR 1.46，95%置信区间1.11 - 1.91；I² = 82%；P =.006）。另一方面，与对照组相比，数字健康干预使T2DM发病率降低12%（RR 0.88，95%置信区间0.77 - 1.01；I² = 0.6%；P =.06）。此外，数字与面对面相结合的混合干预使T2DM发病率降低37%（RR 0.63，95%置信区间0.49 - 0.81；I² < 0.01%；P <.001），恢复正常血糖的比例增加87%（RR 1.87，95%置信区间1.30 - 2.69；I² = 23%；P =.001）。然而，数字健康干预在糖尿病前期逆转至正常血糖方面未观察到显著效果。
面对面干预在降低糖尿病前期成年人T2DM发病率和恢复正常血糖方面一直显示出有前景的有效性。然而，数字健康干预在这些方面的有效性尚未得到充分证实。鉴于这些结果，未来需要进一步研究以提供关于数字健康和混合干预在预防T2DM方面更确凿的证据。
PROSPERO CRD42023414313；https://tinyurl.com/55ac4j4n。
