Effects of multimodal mobile health interventions on cardiovascular risk factor management in patients with diabetes: a systematic review and meta-analysis.

Abstract

Diabetes mellitus significantly increases the risk of cardiovascular disease (CVD). While mobile health (mHealth) interventions show promise, there is limited evidence on the efficacy of multimodal approaches for managing comprehensive CVD risk factors. This systematic review and meta-analysis aimed to evaluate the effectiveness of multimodal mHealth interventions in managing CVD risk factors in patients with diabetes. Systematic review and meta-analysis of randomised controlled trials (RCTs), reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. MEDLINE, Web of Science, Embase, Cochrane Library and CINAHL were searched for RCTs published from January 2010 to December 2024. RCTs involving adults (≥18 years) with diabetes who received multimodal mHealth interventions (incorporating at least three components such as mobile apps, remote monitoring and SMS reminders) for ≥3 months, compared with standard care, were included. Two independent reviewers screened records, extracted data and assessed the risk of bias using the original Cochrane risk of bias (RoB) tool. Perform effect size pooling using R V.4.4.3 and report the corresponding results, taking into account the observed heterogeneity. Out of 2730 screened records, 17 RCTs (n=2946 participants) met the inclusion criteria. Multimodal mHealth interventions significantly reduced haemoglobin A1c (HbA1c) (weighted mean difference (WMD) = -0.38%, 95% CI -0.52 to -0.24; p<0.0001), fasting glucose (WMD=-14.10 mg/dL, 95% CI -20.89 to -7.30; p<0.0001), systolic blood pressure (WMD=-1.30 mm Hg, 95% CI -2.12 to -0.47; p=0.0021), low-density lipoprotein cholesterol (WMD=-6.07 mg/dL, 95% CI -9.45 to -2.68; p=0.0004), total cholesterol (WMD=-5.40 mg/dL, 95% CI -9.85 to -0.93; p=0.0177) and triglycerides (WMD=-6.50 mg/dL, 95% CI -12.65 to -0.35; p=0.0383). The interventions also increased physical activity participation (OR=3.41, 95% CI 1.16 to 10.05; p=0.0259). No significant effects were observed on body mass index, diastolic blood pressure, high-density lipoprotein cholesterol, smoking cessation or adverse event rates. Multimodal mHealth interventions are effective in improving several key cardiometabolic parameters, including glycaemic control, blood pressure, lipid profiles and physical activity levels in patients with diabetes. These interventions represent a promising strategy for comprehensive CVD risk factor management in this population. CRD420251050970. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251050970.