Eficacia de la terapéutica digital móvil para mejorar el control glucémico en pacientes con diabetes mellitus tipo 2. Revisión sistemática

Jesús Sánchez Lozano; Sandra Martínez Pizarro

Jesús Sánchez Lozano Centro de Fisioterapia Fisalde (Granada, España)
Sandra Martínez Pizarro Distrito Sanitario de Granada, Servicio Andaluz de Salud (Granada, España)

Palabras clave: Diabetes mellitus tipo 2, Glucemia, Revisión, Terapéutica digital

Key-words: Type 2 diabetes mellitus, Glycemia, Review, Digital therapeutics

Resumen

Introducción: La diabetes tipo 2 es un trastorno metabólico caracterizado por hiperglucemia en el contexto de resistencia a la insulina. Se estima que 415 millones de personas presentan diabetes a nivel mundial. Recientemente se ha desarrollado la terapéutica digital móvil con múltiples herramientas y aplicaciones para ayudar a los pacientes a elegir sabiamente y mejorar la adherencia al autocontrol de la enfermedad. El objetivo de este trabajo fue analizar la eficacia de la terapéutica digital móvil para mejorar el control glucémico en pacientes con diabetes mellitus tipo 2. Método: Se realizó una revisión sistemática de los últimos diez años (2014-2024) siguiendo la metodología PRISMA. Se consultaron las bases de datos de PubMed, CINAHL, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, Cochrane Library, SciELO, y Web Of Science (WOS). Resultados: Se obtuvieron 132 estudios de las bases de datos. Tras eliminar los duplicados y aplicar los criterios de inclusión quedaron 6 ensayos. La muestra fue de 1.527 pacientes. La duración del tratamiento osciló entre 12 y 52 semanas. Todos mostraron seguridad, tolerabilidad y no se produjeron importantes efectos secundarios. Conclusiones: La terapéutica digital móvil es eficaz para mejorar el control glucémico en pacientes con diabetes mellitus tipo 2 medido a través de los niveles de hemoglobina glicosilada. Además, también mejora la autoeficacia en diabetes, la depresión, la actividad física medida con el número diario de pasos, la calidad de vida, la presión arterial, la glucosa en ayunas, la satisfacción y la motivación para la adherencia a la medicación

Abstract

Introduction: Type 2 diabetes is a metabolic disorder characterized by hyperglycemia in the context of insulin resistance. An estimated 415 million people worldwide have diabetes. Mobile digital therapeutics have recently been developed with multiple tools and applications to help patients choose wisely and improve adherence to self-management of the disease. The objective of this study was to analyze the effectiveness of mobile digital therapeutics in improving glycemic control in patients with type 2 diabetes mellitus. Method: A systematic review of the last ten years (2014-2024) was carried out following the PRISMA guidelines. The PubMed, CINAHL, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, Cochrane Library, SciELO, and Web Of Science (WOS) databases were consulted. Results: 132 studies were retrieved from the databases. After eliminating duplicates and applying the inclusion criteria, six trials remained. The sample consisted of 1,527 patients. Treatment duration ranged from 12 to 52 weeks. All trials demonstrated safety and tolerability, and there were no major side effects. Conclusions: Mobile digital therapeutics are effective in improving glycemic control in patients with type 2 diabetes mellitus, measured through glycated hemoglobin levels. Furthermore, they also improve diabetes self-efficacy, depression, physical activity measured by daily step count, quality of life, blood pressure, fasting glucose, satisfaction, and motivation for medication adherence

Bibliografía

1. Tinajero MG, Malik VS. An Update on the Epidemiology of Type 2 Diabetes: A Global Perspective. Endocrinol Metab Clin North Am. 2021 Sep;50(3):337-355. doi: 10.1016/j.ecl.2021.05.013.

2. da Rocha RB, Silva CS, Cardoso VS. Self-Care in Adults with Type 2 Diabetes Mellitus: A Systematic Review. Curr DiabetesRev.2020;16(6):598-607. doi: 10.2174/1573399815666190702161849.

3. Nauck MA, Wefers J, Meier JJ. Treatment of type 2 diabetes: challenges, hopes, and anticipated successes. Lancet Diabetes Endocrinol. 2021 Aug;9(8):525-544. doi:10.1016/S2213-8587(21)00113-3.

4. Cloete L. Diabetes mellitus: an overview of the types, symptoms, complications and management. Nurs Stand. 2022 Jan 5;37(1):61-66. doi: 10.7748/ns.2021.e11709.

5. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care. 2023 Jan 1;46(Suppl 1):S19-S40. doi: 10.2337/dc23-S002.

6. Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, et al. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care. 2023 Oct 1;46(10):e151-e199. doi: 10.2337/dci23-0036.

7. Ruze R, Liu T, Zou X, Song J, Chen Y, Xu R, et al. Obesity and type 2 diabetes mellitus: connections in epidemiology, pathogenesis, and treatments. Front Endocrinol (Lausanne). 2023 Apr 21; 14:1161521. doi: 10.3389/fendo.2023.1161521.

8. Ling C, Bacos K, Rönn T. Epigenetics of type 2 diabetes mellitus and weight change - a tool for precision medicine? Nat Rev Endocrinol. 2022 Jul;18(7):433-448. doi: 10.1038/s41574-022-00671-w.

9. Shrivastava TP, Goswami S, Gupta R, Goyal RK. Mobile App Interventions to Improve Medication Adherence Among Type 2 Diabetes Mellitus Patients: A Systematic Review of Clinical Trials. J Diabetes Sci Technol. 2023 Mar;17(2):458-466. doi: 10.1177/19322968211060060.

10. de Souza Ferreira E, de Aguiar Franco F, Dos Santos Lara MM, Levcovitz AA, Dias MA, Moreira TR, et al. The effectiveness of mobile application for monitoring diabetes mellitus and hypertension in the adult and elderly population: systematic review and meta-analysis. BMC Health Serv Res. 2023 Aug 12;23(1):855. doi: 10.1186/s12913-023-09879-6.

11. Teo JYC, Ramachandran HJ, Jiang Y, Seah CWA, Lim ST, Nguyen HD, et al. The characteristics and acceptance of Technology-Enabled diabetes prevention programs (t-DPP) amongst individuals with prediabetes: A scoping review. J Clin Nurs. 2023 Sep;32(17-18):5562-5578. doi:10.1111/jocn.16649.

12. Parekh N, He H, Zhang Y, Wylie-Rosett J. Dietary Self-Management Using Mobile Health Technology for Adults With Type 2 Diabetes: A Scoping Review. J Diabetes Sci Technol. 2023 Sep;17(5):1212-1225. doi: 10.1177/19322968231174038.

13. Yap JM, Tantono N, Wu VX, Klainin-Yobas P. Effectiveness of technology-based psychosocial interventions on diabetes distress and health-relevant outcomes among type 2 diabetes mellitus: A systematic review and meta-analysis. J Telemed Telecare. 2024 Feb;30(2): 262-284. doi: 10.1177/1357633X211058329.

14. Simmons K, Riddley S. Diabetes and Technology. Prim Care. 2022 Jun;49(2):327-337. doi: 10.1016/j.pop.2021.11.005.

15. Kallas D, Sandhu N, Gandilo C, Schleicher M, Banks L, Jabara M, et al. Use of Digital Health Technology in Heart Failure and Diabetes: a Scoping Review. J Cardiovasc Transl Res. 2023 Jun;16(3):526-540. doi: 10.1007/s12265-022- 10273-6.

16. Sharma V, Feldman M, Sharma R. Telehealth Technologies in Diabetes Self-management and Education. J Diabetes Sci Technol. 2024 Jan;18(1):148-158. doi:10.1177/19322968221093078.

17. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol. marzo de 2021; 19:26.

18. Mamédio C, Andrucioli M, Cuce M. The PICO strategy for the research question construction and evidence research. Rev Latino-Am Enfermagem 2007; 15:508- 11.

19. Higgins JPT, Thomas J. Cochrane Handbook for Systematic Reviews of Interventions. 2.aed. WILEY Blackwell; 2019.

20. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. diciembre de 2016;5(1):210.

21. Young HM, Miyamoto S, Dharmar M, Tang-Feldman Y. Nurse Coaching and Mobile Health Compared With Usual Care to Improve Diabetes Self-Efficacy for Persons With Type 2 Diabetes: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2020 Mar 2;8(3):e16665. Doi:10.2196/16665.

22. Gong E, Baptista S, Russell A, Scuffham P, Riddell M, Speight J, et al. My Diabetes Coach, a Mobile App-Based Interactive Conversational Agent to Support Type 2 Diabetes Self-Management: Randomized Effectiveness- Implementation Trial. J Med Internet Res. 2020 Nov 5;22(11):e20322. Doi: 10.2196/20322.

23. Yang Y, Lee EY, Kim HS, Lee SH, Yoon KH, Cho JH. Effect of a Mobile Phone-Based Glucose- Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial. JMIR Mhealth Uhealth. 2020 Feb 26;8(2):e16266. Doi: 10.2196/16266.

24. Lim SL, Ong KW, Johal J, Han CY, Yap QV, Chan YH, et al. Effect of a Smartphone App on Weight Change and Metabolic Outcomes in Asian Adults With Type 2 Diabetes: A Randomized Clinical Trial. JAMA Netw Open. 2021 Jun 1;4(6):e2112417. doi: 10.1001/jamanetworkopen.2021.12417.

25. Lee EY, Cha SA, Yun JS, Lim SY, Lee JH, Ahn YB, et al. Efficacy of Personalized Diabetes Self-care Using an Electronic Medical Record-Integrated Mobile App in Patients With Type 2 Diabetes: 6-Month Randomized Controlled Trial. J Med Internet Res. 2022 Jul 28;24(7):e37430. Doi:10.2196/37430.

26. Kim G, Kim S, Lee YB, Jin SM, Hur KY, Kim JH. A randomized controlled trial of an app-based intervention on physical activity and glycemic control in people with type 2 diabetes. BMC Med. 2024 May 1;22(1):185. doi:10.1186/s12916-024-03408-w.

27. Rodriguez-León C, Villalonga C, Munoz-Torres M, Ruiz JR, Banos O. Mobile and Wearable Technology for the Monitoring of Diabetes-Related Parameters: Systematic Review. JMIR Mhealth Uhealth. 2021 Jun 3;9(6):e25138. Doi: 10.2196/25138.

28. Wu X, Guo X, Zhang Z. The Efficacy of Mobile Phone Apps for Lifestyle Modification in Diabetes: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth. 2019 Jan 15;7(1):e12297. Doi: 10.2196/12297.

29. Sabahi A, Jalali S, Ameri F, Garavand A, Negahban A. The effect of using mobile health on self- management of type 2 diabetic patients: A systematic review in Iran. J Educ Health Promot. 2023 Oct 31;12:358. doi: 10.4103/jehp.jehp_910_22.

30. Tarricone R, Petracca F, Svae L, Cucciniello M, Ciani O. Which behaviour change techniques work best for diabetes self-management mobile apps? Results from a systematic review and meta- analysis of randomised controlled trials. EBioMedicine. 2024 May;103:105091. doi: 10.1016/j.ebiom.2024

Eficacia de la terapéutica digital móvil para mejorar el control glucémico en pacientes con diabetes mellitus tipo 2. Revisión sistemática

Effectiveness of mobile digital therapeutics to improve glycemic control in patients with type 2 diabetes mellitus. Systematic review

Resumen

Abstract

Bibliografía