Lifestyle interventions based on the diabetes prevention program delivered via eHealth: A systematic review and meta-analysis

Abstract

The objective was to describe Diabetes Prevention Program (DPP)-based lifestyle interventions delivered via electronic, mobile, and certain types of telehealth (eHealth) and estimate the magnitude of the effect on weight loss. A systematic review was conducted. PubMed and EMBASE were searched for studies published between January 2003 and February 2016 that met inclusion and exclusion criteria. An overall estimate of the effect on mean percentage weight loss across all the interventions was initially conducted. A stratified meta-analysis was also conducted to determine estimates of the effect across the interventions classified according to whether behavioral support by counselors post-baseline was not provided, provided remotely with communication technology, or face-to-face. Twenty-two studies met the inclusion/exclusion criteria, in which 26 interventions were evaluated. Samples were primarily white and college educated. Interventions included Web-based applications, mobile phone applications, text messages, DVDs, interactive voice response telephone calls, telehealth video conferencing, and video on-demand programing. Nine interventions were stand-alone, delivered post-baseline exclusively via eHealth. Seventeen interventions included additional behavioral support provided by counselors post-baseline remotely with communication technology or face-to-face. The estimated overall effect on mean percentage weight loss from baseline to up to 15months of follow-up across all the interventions was -3.98%. The subtotal estimate across the stand-alone eHealth interventions (-3.34%) was less than the estimate across interventions with behavioral support given by a counselor remotely (-4.31%), and the estimate across interventions with behavioral support given by a counselor in-person (-4.65%). There is promising evidence of the efficacy of DPP-based eHealth interventions on weight loss. Further studies are needed particularly in racially and ethnically diverse populations with limited levels of educational attainment. Future research should also focus on ways to optimize behavioral support.

Keywords: Diabetes mellitus, type 2; Risk reduction behavior; Telemedicine.

Copyright © 2017 Elsevier Inc. All rights reserved.

Figures

Figure 1

Flow chart of literature search and selection process * Categories are mutually exclusive Abbreviations: DPP-Diabetes Prevention Program

Figure 2

Forest plot displaying the overall random-effects estimate and the subtotal estimate stratified by behavioral support of the inverse-variance weighted random-effects (DerSimonian and Laird) meta-analysis of the effect of Diabetes Prevention Program based eHealth interventions on mean percentage weight change

Figure 3

Funnel plot of data from 25 DPP-based eHealth interventions