Duong Tuan, Olsen Quita, Menon Anish, Woods Leanna, Wang Wenyong, Varnfield Marlien, Jiang Lee, Sullivan Clair
Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Family Medicine Department, University of Medicine and Pharmacy, Hue, Vietnam.
J Med Internet Res. 2025 Apr 25;27:e67507. doi: 10.2196/67507.
Digital health interventions (DHIs) have rapidly evolved and significantly revolutionized the health care system. The quadruple aims of health care (improving population health, enhancing consumer experience, enhancing health care provider [HCP] experience, and decreasing health costs) serve as a strategic guiding framework for DHIs. It is unknown how DHIs can impact the burden of type 2 diabetes mellitus (T2DM), as measured by the quadruple aims.
This study aimed to systematically review the effects of DHIs on improving the burden of T2DM, as measured by the quadruple aims.
PubMed, Embase, CINAHL, and Web of Science were searched for studies published from January 2014 to March 2024. Primary outcomes were the development of T2DM, hemoglobin A (HbA) change, and blood glucose change (dysglycemia changes). Secondary outcomes were consumer experience, HCP experience, and health care costs. Outcomes were mapped to the quadruple aims. DHIs were categorized using the World Health Organization's DHI classification. For each study, DHI categories were assessed for their effects on each outcome, categorizing the effects as positive, negative, or neutral. The overall effects of each DHI category were determined by synthesizing all reported positive, neutral, or negative effects regardless of the number of studies supporting each effect. The Cochrane risk-of-bias version 2 (RoB 2) tool for randomized trials was used to assess the quality of randomized controlled trials (RCTs), while the ROBINS-I (risk of bias in nonrandomized studies of interventions) tool was applied for nonrandomized studies.
In total, 53 papers were included. For the T2DM development outcome, the effects of DHIs were positive in 1 (1.9%) study and neutral in 9 (17%) studies, and there were insufficient data to assess in 4 (7.5%) studies. For the dysglycemia outcome, the effects were positive in 23 (43.4%) studies and neutral in 24 (45.3%) studies, and there were insufficient data in 6 (11.3%) studies. There were mixed effects on consumer experience (n=13, 24.5%) and a lack of studies reporting HCP experience (n=1, 1.9%) and health care costs (n=3, 5.7%). All studies that reported positive population health outcomes used a minimum of 2 distinct categories of DHIs. Among these successful studies, the one that reported delaying the development of T2DM and 16 (69.6%) of those reporting improvements in dysglycemia involved HCP interaction. Targeted communication with persons (TCP), personal health tracking (PHT), and telemedicine (TM) showed some evidence as a potentially useful tool for T2DM prevention and dysglycemia.
The effects of DHIs on T2DM prevention, as measured by the quadruple aims, have not been comprehensively assessed, with proven benefits for population health, mixed results for consumer experience, and insufficient studies on HCP experience and health care costs. To maximize their effectiveness in preventing T2DM and managing dysglycemia, DHIs should be used in combination and strategically integrated with in-person or remote HCP interaction.
PROSPERO CRD42024512690; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024512690.
数字健康干预措施（DHIs）迅速发展，给医疗保健系统带来了重大变革。医疗保健的四重目标（改善人群健康、提升消费者体验、提升医疗保健提供者[HCP]体验以及降低医疗成本）是数字健康干预措施的战略指导框架。目前尚不清楚数字健康干预措施如何影响2型糖尿病（T2DM）负担，而这是通过四重目标来衡量的。
本研究旨在系统评价数字健康干预措施对改善2型糖尿病负担的影响，这是通过四重目标来衡量的。
检索PubMed、Embase、CINAHL和Web of Science数据库中2014年1月至2024年3月发表的研究。主要结局为2型糖尿病的发生、糖化血红蛋白（HbA）变化以及血糖变化（血糖异常变化）。次要结局为消费者体验、医疗保健提供者体验和医疗成本。将结局映射到四重目标。使用世界卫生组织的数字健康干预分类对数字健康干预措施进行分类。对于每项研究，评估数字健康干预分类对每个结局的影响，将影响分类为积极、消极或中性。通过综合所有报告的积极、中性或消极影响来确定每个数字健康干预分类的总体影响，而不考虑支持每种影响的研究数量。使用Cochrane随机对照试验偏倚风险第2版（RoB 2）工具评估随机对照试验（RCT）的质量，而对于非随机研究则应用ROBINS-I（干预非随机研究中的偏倚风险）工具。
共纳入53篇论文。对于2型糖尿病发生结局，数字健康干预措施在1项（1.9%）研究中的影响为积极，在9项（17%）研究中的影响为中性，在4项（7.5%）研究中数据不足无法评估。对于血糖异常结局，23项（43.4%）研究中的影响为积极，24项（45.3%）研究中的影响为中性，6项（11.3%）研究中数据不足。对消费者体验有混合影响（n = 13，24.5%），且缺乏报告医疗保健提供者体验（n = 1，1.9%）和医疗成本（n = 3，5.7%）的研究。所有报告人群健康结局为积极的研究至少使用了2种不同类别的数字健康干预措施。在这些成功的研究中，报告延迟2型糖尿病发生的研究以及报告血糖异常改善的研究中有16项（69.6%）涉及医疗保健提供者互动。针对个人的定向沟通（TCP）、个人健康追踪（PHT）和远程医疗（TM）显示出一些证据，表明其作为预防2型糖尿病和血糖异常的潜在有用工具。
通过四重目标衡量，数字健康干预措施对2型糖尿病预防的影响尚未得到全面评估，对人群健康有已证实的益处，消费者体验结果不一，且关于医疗保健提供者体验和医疗成本的研究不足。为了最大限度地提高其在预防2型糖尿病和管理血糖异常方面的有效性，数字健康干预措施应联合使用，并与面对面或远程医疗保健提供者互动进行战略整合。
PROSPERO CRD42024512690；https://www.crd.york.ac.uk/PROSPERO/view/CRD42024512690。
