Effects of Digital Intelligent Interventions on Self-Management of Patients With Diabetic Foot: Systematic Review.

BACKGROUND

Diabetic foot (DF) is one of the most common and serious complications of diabetes. Effective self-management by patients can delay disease progression and improve quality of life. Digital intelligent technologies have emerged as advantageous in assisting patients with chronic diseases in self-management. However, the impact of digital intelligent technologies on self-management of patients with DF remains unclear.

OBJECTIVE

This systematic review aimed to determine the effects of digital intelligent interventions on self-management in patients with DF.

METHODS

A systematic literature search was conducted across PubMed, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trial, ProQuest, China National Knowledge Internet, WanFang, China Science and Technology Journal Database, and SinoMed up to February 6, 2025, to identify eligible articles. Randomized controlled trials (RCTs) that assessed the effects of digital intelligent interventions on self-management of patients with DF were included. In total, 2 researchers independently conducted literature screening, quality assessment, and data extraction. The Cochrane Risk of Bias 2.0 tool (revised version 2019) for RCTs was used to assess the quality of the studies. A qualitative synthesis was conducted on the extracted data.

RESULTS

In total, 1079 articles were retrieved, and 18 RCTs were included. All studies were rated as having a high risk of bias. The digital intelligent interventions in the included studies varied in forms, components, and durations. The intervention forms included WeChat (Tencent Holdings Limited; 7/18, 39%), apps (4/18, 22%), electronic platforms (3/18, 17%), mixed interventions (3/18, 17%), and smartphone thermography (1/18, 6%). The intervention components included self-management education (17/18, 94%), blood glucose and foot condition monitoring (8/18, 44%), self-management supervision and follow-up (6/18, 33%), and other components like foot risk assessment, foot care reminders, visit reminders, and remote consultations. Intervention durations ranged from 5 weeks to 12 months, with the majority (10/18, 56%) lasting 6 months. Among the 18 included studies, 17 studies (17/18, 94%) indicated that, compared with routine care, digital intelligent interventions significantly improved the self-management behaviors of patients with DF, including diabetes control, foot care behaviors, and blood glucose monitoring. Only 1 study (1/18, 6%) showed that the effects of digital intelligent interventions were not significantly different from those of routine care.

CONCLUSIONS

In this systematic review, evidence suggests that digital intelligent interventions can improve self-management behaviors and capabilities in patients with DF. However, due to the overall low quality of the included studies, current evidence should be interpreted and applied with caution. This field is still in the exploratory stage, with significant heterogeneity among different studies and a lack of consensus on intervention strategies, necessitating further exploration tailored to different populations. Future RCTs with large sample sizes and rigorous design are needed to develop high-quality evidence.

TRIAL REGISTRATION

PROSPERO CRD42024524473; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524473.