BACKGROUND: Diabetes is a common chronic disease that places an unprecedented strain on health care systems worldwide. Mobile health technologies such as smartphones, mobile applications, and wearable devices, known as mHealth, offer significant and innovative opportunities for improving patient to provider communication and self-management of diabetes.
OBJECTIVE: The purpose of this overview is to critically appraise and consolidate evidence from multiple systematic reviews on the effectiveness of mHealth interventions for patients with diabetes to inform policy makers, practitioners, and researchers.
METHODS: A comprehensive search on multiple databases was performed to identify relevant systematic reviews published between January 1996 and December 2015. Two authors independently selected reviews, extracted data, and assessed the methodological quality of included reviews using AMSTAR.
RESULTS: Fifteen systematic reviews published between 2008 and 2014 were eligible for inclusion. The quality of the reviews varied considerably and most of them had important methodological limitations. Focusing on systematic reviews that offered the most direct evidence, this overview demonstrates that on average, mHealth interventions improve glycemic control (HbA1c) compared to standard care or other non-mHealth approaches by as much as 0.8% for patients with type 2 diabetes and 0.3% for patients with type 1 diabetes, at least in the short-term (≤12 months). However, limitations in the overall quality of evidence suggest that further research will likely have an important impact in these estimates of effect.
CONCLUSIONS: Findings are consistent with clinically relevant improvements, particularly with respect to patients with type 2 diabetes. Similar to home telemonitoring, mHealth interventions represent a promising approach for self-management of diabetes.
ANTECEDENTES: Esta crítica fue el encargado de generar un amplio debate acerca de cómo seleccionar los modos de entrega de intervención en el diseño de una intervención compleja, preventiva dirigida a las enfermedades crónicas a través de la promoción de la actividad física, la dieta saludable y / o adherencia a la medicación. En este contexto, nos preguntamos, ¿cuáles son los modos de entrega? ¿Cuáles son las consideraciones de diseño importantes? ¿Y cómo éstas se comparan (por ejemplo, las fortalezas, limitaciones)?
MATERIAL Y MÉTODOS: Esta revisión utilizaron los métodos de revisión rápida, una metodología emergente que surge de evaluación de tecnologías sanitarias. La estrategia de búsqueda se aplicó en Embase y MEDLINE. Una síntesis cualitativa, la narrativa se realizó en los artículos incluidos.
RESULTADOS: Después de la selección, 21 artículos se mantuvieron para la síntesis (10 revisiones sistemáticas, incluyendo 1 opinión de opiniones; cuatro ensayos o estudios, tres comentarios o actas de congresos, y 2 eran proyectos de alcance). Nuestra síntesis determinó que las principales categorías de las consideraciones de diseño al seleccionar los modos de entrega de intervención incluyen la atención a los (i) tipos de modo de candidato, (ii) la configuración y el entorno social, (iii) la intensidad y el tiempo, (iv) el proveedor, (v) población de estudio y los participantes, (vi) los costos, (vii) la técnica de cambio de comportamiento y (viii) base teórica.
CONCLUSIÓN: Una serie de modos de entrega está disponible para cada una de las estrategias de intervención en estudio (es decir, la actividad física, el cambio de dieta y adherencia a la medicación). Sin modo de entrega solo era claramente más adecuado o más efectivo que otro, cada uno con fortalezas y las limitaciones particulares. Las decisiones de modo de entrega que tienen los factores antes mencionados (I-VIII) en cuenta estarán más aptos para el propósito que los que no lo hacen.
Diabetes is a common chronic disease that places an unprecedented strain on health care systems worldwide. Mobile health technologies such as smartphones, mobile applications, and wearable devices, known as mHealth, offer significant and innovative opportunities for improving patient to provider communication and self-management of diabetes.
OBJECTIVE:
The purpose of this overview is to critically appraise and consolidate evidence from multiple systematic reviews on the effectiveness of mHealth interventions for patients with diabetes to inform policy makers, practitioners, and researchers.
METHODS:
A comprehensive search on multiple databases was performed to identify relevant systematic reviews published between January 1996 and December 2015. Two authors independently selected reviews, extracted data, and assessed the methodological quality of included reviews using AMSTAR.
RESULTS:
Fifteen systematic reviews published between 2008 and 2014 were eligible for inclusion. The quality of the reviews varied considerably and most of them had important methodological limitations. Focusing on systematic reviews that offered the most direct evidence, this overview demonstrates that on average, mHealth interventions improve glycemic control (HbA1c) compared to standard care or other non-mHealth approaches by as much as 0.8% for patients with type 2 diabetes and 0.3% for patients with type 1 diabetes, at least in the short-term (≤12 months). However, limitations in the overall quality of evidence suggest that further research will likely have an important impact in these estimates of effect.
CONCLUSIONS:
Findings are consistent with clinically relevant improvements, particularly with respect to patients with type 2 diabetes. Similar to home telemonitoring, mHealth interventions represent a promising approach for self-management of diabetes.
Síntesis amplia»Revisión panorámica de revisiones sistemáticas
