The Efficacy of Mobile Phone Apps for Lifestyle Modification in Diabetes: Systematic Review and Meta-Analysis (Preprint)

Mapping Intimacies ◽

10.2196/preprints.12297 ◽

2018 ◽

Author(s):

Xinghan Wu ◽

Xitong Guo ◽

Zhiwei Zhang

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Mobile Phone ◽

Lifestyle Modification ◽

Meta Analysis ◽

Short Term

BACKGROUND Diabetes and related complications are estimated to cost US $727 billion worldwide annually. Type 1 diabetes, type 2 diabetes, and gestational diabetes are three subtypes of diabetes that share the same behavioral risk factors. Efforts in lifestyle modification, such as daily physical activity and healthy diets, can reduce the risk of prediabetes, improve the health levels of people with diabetes, and prevent complications. Lifestyle modification is commonly performed in a face-to-face interaction, which can prove costly. Mobile phone apps provide a more accessible platform for lifestyle modification in diabetes. OBJECTIVE This review aimed to summarize and synthesize the clinical evidence of the efficacy of mobile phone apps for lifestyle modification in different subtypes of diabetes. METHODS In June 2018, we conducted a literature search in 5 databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and PsycINFO). We evaluated the studies that passed screening using The Cochrane Collaboration’s risk of bias tool. We conducted a meta-analysis for each subtype on the mean difference (between intervention and control groups) at the posttreatment glycated hemoglobin (HbA1c) level. Where possible, we analyzed subgroups for short-term (3-6 months) and long-term (9-12 months) studies. Heterogeneity was assessed using the I2 statistic. RESULTS We identified total of 2669 articles through database searching. After the screening, we included 26 articles (23 studies) in the systematic review, of which 18 studies (5 type 1 diabetes, 11 type 2 diabetes, and 2 prediabetes studies) were eligible for meta-analysis. For type 1 diabetes, the overall effect on HbA1c was statistically insignificant (P=.46) with acceptable heterogeneity (I2=39%) in the short-term subgroup (4 studies) and significant heterogeneity between the short-term and long-term subgroups (I2=64%). Regarding type 2 diabetes, the overall effect on HbA1c was statistically significant (P<.01) in both subgroups, and when the 2 subgroups were combined, there was virtually no heterogeneity within and between the subgroups (I2 range 0%-2%). The effect remained statistically significant (P<.01) after adjusting for publication bias using the trim and fill method. For the prediabetes condition, the overall effect on HbA1c was statistically insignificant (P=.67) with a large heterogeneity (I2=65%) between the 2 studies. CONCLUSIONS There is strong evidence for the efficacy of mobile phone apps for lifestyle modification in type 2 diabetes. The evidence is inconclusive for the other diabetes subtypes.

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Impact of COVID-19 lockdown on glycemic control in patients with type 1 and type 2 diabetes mellitus: a systematic review

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00705-9 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Claudia Eberle ◽

Stefanie Stichling

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Glycemic Control ◽

Meta Analysis ◽

Mean Difference ◽

Cochrane Library ◽

Short Term ◽

The Impact

Abstract Background In 2019, a new virus known as severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has emerged. Coronavirus disease 2019 (COVID-19) was classified as a pandemic in a short period of time. In order to reduce the spread of COVID-19, many countries have imposed a lockdown with movement restrictions, social distancing and home confinement, which has affected routine healthcare activities and everyday life. The aim of this systematic review was to examine the impact of the COVID-19 lockdown on glycemic control in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). Methods We systematically identified studies by searching the databases Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, EMBASE, and CINAHL until April 2021. We included n = 33 observational studies of which n = 25 investigated T1D and n = 8 T2D. Results Overall, we analyzed n = 2881 T1D patients and n = 1823 T2D patients. Glycemic values in patients with T1D improved significantly during lockdown. Overall, n = 18 (72%) T1D studies indicated significant improvements in glycemic outcomes. Meta-analysis revealed a mean difference in HbA1c of − 0.05% (95% CI − 0.31 to 0.21) due to lockdown, and in time in range (TIR) of + 3.75% (95% CI 2.56 to 4.92). Lockdown determined a short-term worsening in glycemic values in patients with T2D. Overall, n = 4 (50%) publications observed deteriorations in glycemic control. Meta-analysis demonstrated a mean difference in HbA1c of + 0.14 (95% CI − 0.13 to 0.40) through the lockdown. Moreover, n = 3 (75%) studies reported a not significant deterioration in body weight. Conclusions Glycemic values in people with T1D significantly improved during COVID-19 lockdown, which may be associated with positive changes in self-care and digital diabetes management. In contrast, lockdown rather determined a short-term worsening in glycemic parameters in patients with T2D. Further research is required, particularly into the causes and effective T2D management during lockdown.

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Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-002035 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002035

Author(s):

Merel M Ruissen ◽

Hannah Regeer ◽

Cyril P Landstra ◽

Marielle Schroijen ◽

Ingrid Jazet ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Weight Gain ◽

Glycemic Control ◽

Perceived Stress ◽

Medical Center ◽

Short Term ◽

Design And Methods

IntroductionLockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes.Research design and methodsWe performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown.ResultsIn total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: −0.39% (−4.3 mmol/mol) (p<0.0001 and type 2 diabetes: −0.62% (−6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001).ConclusionsAn increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.

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