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Diabetesisacommonchronicdiseasethatplacesanunprecedentedstrainonhealthcaresystemsworldwide.Mobilehealthtechnologiessuchassmartphones,mobileapplications,andwearabledevices,knownasmHealth,offersignificantandinnovativeopportunitiesforimprovingpatienttoprovidercommunicationandself-managementofdiabetes.
ThepurposeofthisoverviewistocriticallyappraiseandconsolidateevidencefrommultiplesystematicreviewsontheeffectivenessofmHealthinterventionsforpatientswithdiabetestoinformpolicymakers,practitioners,andresearchers.
AcomprehensivesearchonmultipledatabaseswasperformedtoidentifyrelevantsystematicreviewspublishedbetweenJanuary1996andDecember2015.Twoauthorsindependentlyselectedreviews,extracteddata,andassessedthemethodologicalqualityofincludedreviewsusingAMSTAR.
Fifteensystematicreviewspublishedbetween2008and2014wereeligibleforinclusion.Thequalityofthereviewsvariedconsiderablyandmostofthemhadimportantmethodologicallimitations.Focusingonsystematicreviewsthatofferedthemostdirectevidence,thisoverviewdemonstratesthatonaverage,mHealthinterventionsimproveglycemiccontrol(HbA1c)comparedtostandardcareorothernon-mHealthapproachesbyasmuchas0.8%forpatientswithtype2diabetesand0.3%forpatientswithtype1diabetes,atleastintheshort-term(≤12months).However,limitationsintheoverallqualityofevidencesuggestthatfurtherresearchwilllikelyhaveanimportantimpactintheseestimatesofeffect.
Findingsareconsistentwithclinicallyrelevantimprovements,particularlywithrespecttopatientswithtype2diabetes.Similartohometelemonitoring,mHealthinterventionsrepresentapromisingapproachforself-managementofdiabetes.
Editor:DongmeiLi,UniversityofRochester,UNITEDSTATES
Received:December6,2016;Accepted:February15,2017;Published:March1,2017
DataAvailability:AllrelevantdataarewithinthepaperanditsSupportingInformationfiles.
Funding:Theauthor(s)receivednospecificfundingforthiswork.
Competinginterests:Theauthorshavedeclaredthatnocompetinginterestsexist.
ThisoverviewofSRsaimstocollect,appraise,andsynthesizeevidencefrommultipleSRsandmeta-analysesontheeffectivenessofmHealthinterventionsforpatientswithdiabetes,inordertoprovideresearchers,policymakersandpractitionerswiththeevidencetheyneedtomakeinformeddecisions.Italsoaimstoidentifyresearchgapsthatneedtobeaddressedanddevelopaseriesofrecommendationsforimprovingthequalityoffuturereviewsandstudiesinthisarea.
Tworeviewers(SK&GP)independentlyextracteddatafromeachSRusinganelectronicformthatwasdevelopedforthepurposesofthisstudy.Allextracteddatawerecheckedforconsistencyandanydifferenceswereresolvedbydiscussion.ExtracteddataincludedgeneralinformationabouttheSR(e.g.yearofpublication,origin,journal,andsourcesoffunding)aswellasspecificdetailsabouttheparticipants,interventions,comparisongroups,andoutcomes(PICO)ofthestudiesincludedinthereviews.Citationanalysescross-linkingindividualSRswithincludedstudieswerecarriedoutasameansofidentifyingthetotalnumberofprimarystudiesbystudydesignandtypeofdiabetes,aswellasevaluatingthedegreeofoverlapbetweentheSRs.Resultswereanalyzedandsummarizednarrativelytakingintoconsiderationthemethodologicalquality,scope,andPICOcharacteristicsofeachSR.
Reviewsincludedinoursamplewerepublishedbetween2008and2014.Most(n=9)werepublishedfrom2012onwardwithonethirdofthereviewsbeingpublishedin2013alone.TwooftheSRswereCochranereviews.SixreviewsoriginatedintheUnitedStates,fiveintheUnitedKingdom,twoinChina,oneinCanada,andoneinIran.Despitesomeoverlap,theindividualSRsvariedintheirscopeofinquiryanduseddifferentinclusionandexclusioncriteriafortheselectionofeligiblestudies.
SixSRsfocusedexplicitlyontheeffectsofmHealthinterventionsforpatientswithdiabetes.Theremainingreviewshadabroaderscopeofinquiry:4SRexaminedvariousremotepatientmonitoringinterventionsinadditiontomHealth(e.g.videoandtele-conferencing),and5SRsinvestigatedtheeffectsofmHealthonarangeofchronicconditionsthatincludeddiabetesasanidentifiablesubset.Inlinewithourinclusioncriteria,thesereviewswereincludedinoursamplebecausetheyreportedtheeffectsofmHealthinterventionsfordiabetesseparatelyfromotherinterventionsand/orconditions.
(DOCX)
TheauthorsthankCarlaDeSistoandDanZhaofortheirassistancewithdataextractionandorganizationaswellasKevinBrennan,MollyHuttner,andAshleyUlmfortheirassistancewiththeproductionandrefinementofthefigures.
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