Zhou Jinyan, Ding Shanni, Xu Yihong, Pan Hongying
Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Med Internet Res. 2025 Mar 25;27:e64400. doi: 10.2196/64400.
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.
This systematic review aimed to determine the effects of digital intelligent interventions on self-management in patients with DF.
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.
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.
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.
PROSPERO CRD42024524473; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524473.
糖尿病足（DF）是糖尿病最常见且最严重的并发症之一。患者进行有效的自我管理可延缓疾病进展并提高生活质量。数字智能技术已在协助慢性病患者进行自我管理方面展现出优势。然而，数字智能技术对糖尿病足患者自我管理的影响仍不明确。
本系统评价旨在确定数字智能干预对糖尿病足患者自我管理的效果。
截至2025年2月6日，在PubMed、Web of Science、Embase、护理学与健康相关文献累积索引、PsycINFO、Cochrane对照试验中心注册库、ProQuest、中国知网、万方、中国科技期刊数据库和中国生物医学文献数据库中进行系统文献检索，以识别符合条件的文章。纳入评估数字智能干预对糖尿病足患者自我管理效果的随机对照试验（RCT）。总共2名研究人员独立进行文献筛选、质量评估和数据提取。采用Cochrane偏倚风险2.0工具（2019年修订版）对RCT进行研究质量评估。对提取的数据进行定性综合分析。
共检索到1079篇文章，纳入18项RCT。所有研究均被评为具有高偏倚风险。纳入研究中的数字智能干预在形式、组成部分和持续时间上各不相同。干预形式包括微信（腾讯控股有限公司；7/18，39%）、应用程序（4/18，22%）、电子平台（3/18，17%）、混合干预（3/18，17%）和智能手机热成像（1/18，6%）。干预组成部分包括自我管理教育（17/18，94%）、血糖和足部状况监测（8/18，44%）、自我管理监督和随访（6/18，33%）以及其他组成部分，如足部风险评估、足部护理提醒、就诊提醒和远程会诊。干预持续时间从5周至12个月不等，大多数（10/18，56%）持续6个月。在纳入的18项研究中，17项研究（17/18，94%）表明，与常规护理相比，数字智能干预显著改善了糖尿病足患者的自我管理行为，包括糖尿病控制、足部护理行为和血糖监测。只有1项研究（1/18，6%）表明数字智能干预的效果与常规护理无显著差异。
在本系统评价中，证据表明数字智能干预可改善糖尿病足患者的自我管理行为和能力。然而由于纳入研究的整体质量较低，当前证据在解释和应用时应谨慎。该领域仍处于探索阶段，不同研究之间存在显著异质性，且在干预策略上缺乏共识，需要针对不同人群进行进一步探索。未来需要开展大样本量且设计严谨的RCT以产生高质量证据。
PROSPERO CRD42024524473；https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524473
