Table 2.
Summary of the included studies.
| No. | Author (years) | Interventions | Comparator | Primary outcomes | Secondary outcomes | Results | Conclusions |
|---|---|---|---|---|---|---|---|
| 1. | Kim H-S (2007)[20] | Each patient was instructed to input data into the website www.biodang.com and their self-monitored blood glucose levels and drug information, including the kinds and dosages of insulin and oral anti-diabetic medication they used for diabetes control. Each patient also got optimal recommendations back weekly, by an SMS by cellular phone or wired Internet | Participants in the control group met with an endocrinologist once or twice over 12 wk. The endocrinologist gave recommendations on medication, dosage, and lifestyle modifications when they visited the clinic. More individualized and detailed information relating to lifestyle modification is given when the doctor or patient wants to | HbA1c, FPG, and 2HPMG levels | N/A | This study shows that HbA1c levels decreased significantly by 1.15% in the intervention group after 12 wk, even though the duration of the study was concise. The intervention group also decreased FPG levels of 0.4 mmol/L, but there was no interaction between group and time. The rate of change in blood glucose levels in the control group was not significant. The average rate of change was +0.07. However, there was no significant difference between the groups | The intervention group showed a significant decrease in HbA1c values, but there is no significant difference from the control group |
| 2. | Sacco WP et al (2009)[21] | Patients in the intervention group received telephone coaching with a diabetes coach for 15–20 min. One per week calls for the first 3 mo and 1 bi-weekly call for the remaining 3 mo. Patients also received treatment from an endocrinologist and completed the pretest and post-test | Patients in the control group only received treatment from an endocrinologist and completed the same pretest and post-test measures as the intervention group | HbA1c, BMI, diet, exercise, foot care, depressive symptoms, diabetes symptoms, and therapeutic mechanisms | N/A | This study shows significant positive effects on diabetes-related self-efficacy, self-care activities, and self-care goals. The intervention group improved diet, exercise, foot care, depressive and diabetes symptoms, self-efficacy, and awareness of self-care goals. However, this study failed to find a significant effect in A1c and BMI because they were observed only on face-valid self-report measures to reflect a response bias of positive outcomes | The telephone coaching intervention showed a reduction of depression and diabetic symptoms and improved self-efficacy, self-care activities, and self-care goals. However, it failed to show any effect on glycemic control and BMI |
| 3. | Marios T et al (2012)[22] | All participants were given a 6-mo individualized walking program. Patients were also asked to complete 180 min per week of exercise, and their venous blood was taken to establish serum levels | Same as the intervention group, the control group were given a 6-mo individualized walking program. They were asked to complete 180 min per week of exercise and their Venous blood was taken to establish serum levels. The differences were that control patients did not receive heart rate monitors and phone calls, but were taught the way to take their pulse to monitor heart rate | A home-based exercise program | Peak VO2, HbA1c%, and quality of life | Intervention groups patients completed a mean weekly exercise of 138 min while control group patients completed 58 min weekly | This study shows that telemonitoring groups have improved the weekly exercise, the peak VO2, treadmill time, and maximum heart rate even though there is no significant HbA1c% improvement |
| The improvement of peak VO2, treadmill time, and maximum heart rate in the intervention group are 5.5% (21.8–23.0), 18% (8.31–9.87), and 3% (101–104). Whereas HbA1c% of the telemonitoring group decreased from 7.90 to 7.61, and HbA1c% of the control group decreased from 7.53 to 7.12 | |||||||
| Intervention groups were provided with a heart rate monitor and received weekly phone calls, ranging from 5 to 15 min. Patients were allowed to ask contact their exercise physiologist | |||||||
| 4. | Torbjørnsen A et al (2014)[23] | Two intervention groups: 1. Participants used FTA 2. Participants used FTA-HC with a diabetes specialist |
Participants received usual care | HbA1c target in Norway is ≤7.0% | Self-management (Health Education Impact Questionnaire, heiQ), behavioral change (these were diet and physical activity), also health-related quality of life (SF-36) questionnaire | The FTA intervention may have taken too long, also even more for the FTA-HC group. There was also a limitation of a more significant opportunity for the participants to influence the results. The mean decrease change of HbA1c in the FTA group is 0.23, while the mean change of HbA1c in the FTA-HC group is 0.41, and for the control group who received usual care is 0.39. The blood glucose measurement remains high. This does not decrease rapidly for both FTA and FTA-HC | FTA interventions with or without HC may not be effective enough. FTA and health counseling did not help lower HbA1c levels compared to controls |
| 5. | Holmen H et al (2014)[24] | Two intervention groups: 1. Participants used FTA 2. Participants used FTA-HC by a diabetes specialist |
Participants received usual care | HbA1c level | Self-management (heiQ), health-related quality of life (SF-36), depressive symptoms (CES-D), also lifestyle changes (dietary habits, also physical activity) | HbA1c levels decreased in all groups, but there was no significant difference in changes after 1 year. However; in these 3 groups, the mean HbA1c level did not increase to the baseline level It was shown that there was a significant change in self-management in the FTA-HC group, as they alleviated symptoms and improved their ability to manage their health effectively, also better skills in using technical aids |
Although there is no significant HbA1c level difference, The FTA-HC with diabetes specialists were indicated to be more effective in their health-self management. and reducing patients’ symptoms |
| 6. | Kotsani K et al (2018)[25] | Patients in the intervention group were asked to write down their glucose values in a diary and submit them in 3 ways: via USB connected to a glucose meter, email, or phone call. This group is contacted by telephone every Thursday (10–12 am) for 5–15 min by the nurse-coordinator, discussing possible problems in their disease management and some recommendations based on the data they input | Patients in the control group were asked to write down their glucose values in a diary. The researchers advised patients to submit their data either via USB connected to a glucose meter or by email or collect them to be reviewed at the end of the study. No interaction over the telephone is done in the control group | The measurement of the morning (fasting), preprandial, postprandial glucose level, HbA1c | NA | For the intervention group the morning mean values of blood glucose are 120.01 mg/dL (month 1), 105.96 mg/dL (month 2), and 93.18 mg/dL (month 3); the preprandial mean values of blood glucose are 148.23 mg/dL (month 1), 125.59 mg/dL (month 2), and 114.76 mg/dL (month 3); the post prandial mean values of blood glucose are 248.3 mg/dL (month 1), 215.8 mg/dL (month 2), and 193.35 mg/dL (month 3). And for the control group the morning mean values of blood glucose are 107.18 mg/dL (month 1), 105.96 mg/dL (month 2), and 105.17 mg/dL (month 3); the preprandial mean values of blood glucose are 120.66 mg/dL (month 1), 119.91 mg/dL (month 2), 114.76 mg/dL (month 3); the post prandial mean values of blood glucose are 220.92 mg/dL (month 1), 213.22 mg/dL (month 2), and 207.84 mg/dL (month 3) | There has been a significant improvement in the glucose level in the intervention group |
| 7. | Miremberg H et al (2018)[26] | Patients reported their glucose level using the web-based app (https://www.glucosebuddy.com) and received individual feedback regarding their daily glycemic control every evening (including weekends). They are expected to ask questions by the app, receive answers immediately related to GDM management aspects | Patients in the control group had their first visit, biweekly visits until 35 wk gestation, and weekly at 35 wk gestation until delivery. Patients were also asked to monitor their glucose level 4 times daily (once during the morning fast and after each main meal), and manually record it on a paper diary to be reviewed at each visit | Patient compliance (expressed as a percentage) is defined as the actual blood glucose measurements/instructed measurements times 100 | Diabetes-control parameters: mean blood glucose (mean ± all measured values SD), insulin need treatment, and percentage of off-target measurements (thresholds: fasting > 95 mg/dL and 1-h postprandial > 140 mg/dL) | The patient compliance was higher in the smartphone group compared to the control group (84 ± 0.16% vs 66 ± 0.28%, P < .001). The mean blood glucose shows that it was significantly lower in the smartphone group (105.1 ± 8.6 mg/dL vs 112.6 ± 7.4 mg/dL, P < .001). Insulin treatment’s overall rate was also more diminished in the smartphone group than the control group (13.3% vs 30.0%, P = .044), same with the rates of off-target measurements both fasting (4.7 ± 0.4% vs 8.4 ± 0.6%, P < .001) and 1 h postprandial (7.7 ± 0.8% vs 14.3 ± 0.8%, P < .001) | Patients in the intervention groups show better outcomes (higher compliance, lower mean blood glucose, lower insulin treatment needs, and lower rates of off-target measurements) |
| 8. | Sung J-H et al (2019)[27] | The MM group received standard antenatal care and was given monitoring system devices. Patients recorded their blood glucose concentration and diet using a mobile phone application (Huraypositive Inc, Seoul, Korea). The mobile application received regular messages twice a week about recommendations for adequate diet and exercise during the study period | The CM group received standard antenatal care from obstetricians and endocrinologists, consisting of biweekly visits up to 36 wk of gestation then weekly visits until delivery. Patients were also asked to record their blood glucose concentration 4 times daily and record their intake at each meal | The outcomes divided into obstetrical outcomes (GA at delivery, birth weight, cesarean section) and metabolic outcome (BMI, weight, percentage of body fat, IR, and HbA1c) after delivery measured at 4–12 wk postpartum | N/A | Patients that used mobile phone application for the management of GDM had lower BMI (20.22 kg/m2 vs 23.72 kg/m2), weight (54.31 kg vs 62.58 kg), percentage of body fat (38/12% vs 29.20%), IR (1.97 vs 1.46), and HbA1c (36.75% vs 35.57%) after delivery compared with a conventional management group. No significant difference in glycemic control during pregnancy and perinatal outcome between the MM and CM groups. The mean value of fasting glucose measured in the CM group at 4–12 wk postpartum is 103.63 mg/dL, while in the MM group is 101.43 mg/dL | Patients in MM (intervention) groups show lower levels of the outcomes |
| 9. | Yasmin F et al (2020)[28] | Patients received a mobile phone-based health project (reminder system through interactive voice calls and 24/7 call center services). At the hospital, patients were also given recommendations on medication, diet, physical activity, hospital visits, and lifestyle modification measures | Patients in the control group were only getting regular hospital services | Adherence to medication intake and hospital visit practice, dietary practice, physical exercise, betel nut, tobacco control, blood glucose control consists of the fasting blood glucose level and the blood glucose level by 2 h after breakfast. They are also taking advantage of 24/7 call center services | N/A | It showed a positive impact of adherence to medication intake and hospital visits even though some patients abandoned the medication and hospital visit. The intervention group adhered to carbohydrate and total kilocalorie, vegetable, and fruit intake. There were improvements in the mean exercise number per week (from 4.6 to 6.13 d) in the intervention group and reduction of smoke tobacco (from 2.5% to 1.4%) and betel nut use (from 24% to 8%). Mean fasting and mean blood glucose levels 2 h after breakfast decreased from 8.67 to 6.80 and 12.33 to 9.84 in intervention patients. The call center received 5 calls on average during 1 year period from the intervention group | Participants in the intervention group showed improvement in adherence to diet, physical exercise, betel nut, tobacco control, and blood glucose levels control. It showed good medication adherence also hospital visits, but only a few patients used the free 24/7 call center services |
2HPMG = 2-hour post-meal glucose, BMI = body mass index, CM = conventional management, FPG = fasting plasma glucose, FTA = Few Touch Applications, FTA-HC = Few Touch Applications-Health Counseling, GA = gestational age, HbA1c = glycated hemoglobin A, MM = mobile management.