Comparative efficacy of digitally assisted interventions for glycated haemoglobin levels among patients with type 2 diabetes: A systematic review and component network Meta-Analysis

Aims: To compare the efficacy of digitally assisted interventions on the glycated haemoglobin (HbA1c) levels of patients with type 2 diabetes by performing a systematic review, network meta-analysis and component network meta-analysis. Methods: Six databases were searched to identify eligible articles from the inception of each database until 17 March 2023. We included randomized controlled trials evaluating HbA1c levels. Data were pooled with a random-effects model under a frequentist framework. The evidence certainty was assessed using Confidence in Network MetaAnalysis (CINeMA). The PROSPERO registration number was CRD42021283815. Results: In total, 75 trials involving 9764 participants were included. Results from standard network meta-analyses of 17 interventions revealed that compared with standard care, a mobile application (MA) combined with a professional education programme and peer support education (PSE; −1.98, 95% confidence interval = −2.90 to −1.06, CINeMA score: moderate to high) significantly reduced HbA1c levels. The component analysis found that PSE (−1.50, −2.36 to −0.64), SMS (−0.33, −0.56 to −0.11), MA (−0.30, −0.56 to −0.04) and telephone calls (−0.30, −0.53 to −0.06) most effectively reduced HbA1c levels among patients with type 2 diabetes. Conclusions: SMS and MA are the optimal digitally assisted interventions for reducing HbA1c levels. Educators can integrate digitally assisted interventions complemented by educational programmes, particularly MA combined with professional education programme and PSE, into daily care to control HbA1c. The limitations of included trials include a lack of information on allocation concealment and blinding and the fact that long-term follow-up effects were not investigated.