{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:10:40Z","timestamp":1783703440577,"version":"3.55.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Digital health interventions (DHIs) offer promising strategies for managing type 2 diabetes mellitus (T2DM), yet their efficacy on physical activity remains inconsistent. This systematic review and meta-analysis evaluates DHIs' effectiveness across key clinical endpoints.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Following PRISMA guidelines and PROSPERO registration (CRD420251032375), five databases (Web of Science, Embase, Scopus, Cochrane, PubMed) were searched through February 2025. Randomized controlled trials (RCTs) assessing DHIs (mobile applications, phone calls or SMS, online platforms, remote monitoring) versus usual care in T2DM patients were included. Primary outcomes were HbA1c, fasting blood glucose (FBG), postprandial blood glucose (PBG), HOMA-IR, and physical activity. Risk of bias was evaluated using Cochrane RoB 2. Meta-analyses employed random\/fixed-effect models in Review Manager 5.3, with subgroup and sensitivity analyses for heterogeneity (<jats:italic>I<\/jats:italic>\u00b2 &amp;gt; 50%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 9,499 records, 118 RCTs (21,662 participants) were analyzed. DHIs significantly reduced HbA1c (MD = \u22120.32% to \u22120.54%), FBG (MD = \u22120.30 to \u22120.85), and PBG (SMD = \u22120.58) versus controls (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). Subgroup analyses indicated online platforms most effectively lowered HbA1c (MD = \u22120.54). No improvements occurred in HOMA-IR (MD = \u22120.18, 95% CI: \u22120.79 to 0.44) or physical activity (SMD = 0.16, 95% CI: \u22120.08 to 0.39). Cost analyses revealed lower expenses in DHI groups (mean: $269.31 vs. $465.37). High heterogeneity (<jats:italic>I<\/jats:italic>\u00b2 = 69\u201392%) was observed for glycemic outcomes, partially explained by intervention duration and sample size in meta-regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>DHIs demonstrate robust efficacy for glycemic management in T2DM, particularly through online platforms and remote monitoring. However, they fail to enhance physical activity or insulin resistance. Future studies should prioritize adaptive designs for sustained behavioral change and investigate long-term cost-effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p><jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251032375<\/jats:ext-link>, identifier (CRD420251032375).<\/jats:p><\/jats:sec>","DOI":"10.3389\/fdgth.2025.1630588","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T12:51:12Z","timestamp":1753793472000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["The effectiveness of digital health intervention on glycemic control and physical activity in patients with type 2 diabetes: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"7","author":[{"given":"Haoyuan","family":"Xue","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yarong","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanrong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenshu","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaorong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e63209","DOI":"10.2196\/63209","article-title":"Assessing the effectiveness of digital health behavior strategies on type 2 diabetes management: systematic review and network meta-analysis","volume":"27","author":"Li","year":"2025","journal-title":"J Med Internet Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.2337\/diacare.27.5.1047","article-title":"Global prevalence of diabetes: estimates for the year 2000 and projections for 2030","volume":"27","author":"Wild","year":"2004","journal-title":"Diabetes Care"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1829","DOI":"10.1016\/j.jacc.2018.07.081","article-title":"Blood sugar regulation for cardiovascular health promotion and disease prevention","volume":"72","author":"Schwarz","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"110","DOI":"10.2174\/1570161117666190405165151","article-title":"Macrovascular complications of type 2 diabetes mellitus","volume":"18","author":"Viigimaa","year":"2020","journal-title":"Curr Vasc Pharmacol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"d7163","DOI":"10.1136\/bmj.d7163","article-title":"Risk models and scores for type 2 diabetes: systematic review","volume":"343","author":"Noble","year":"2011","journal-title":"BMJ (Clin Res Ed.)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"16","DOI":"10.2337\/dc16-1358","article-title":"Hba1c and the prediction of type 2 diabetes in children and adults","volume":"40","author":"Vijayakumar","year":"2017","journal-title":"Diabetes Care"},{"key":"B7","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1111\/j.1464-5491.2007.02106.x","article-title":"Hba1c as a screening tool for detection of type 2 diabetes: a systematic review","volume":"24","author":"Bennett","year":"2007","journal-title":"Diabetic Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e010889","DOI":"10.1136\/bmjopen-2015-010889","article-title":"Change in fasting plasma glucose and incident type 2 diabetes mellitus: results from a prospective cohort study","volume":"6","author":"Mozaffary","year":"2016","journal-title":"BMJ Open"},{"key":"B9","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1007\/s001250051617","article-title":"Cost-effectiveness analysis of intensive blood-glucose control with metformin in overweight patients with type II diabetes (UKPDS No. 51)","volume":"44","author":"Clarke","year":"2001","journal-title":"Diabetologia"},{"key":"B10","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1007\/s00125-005-1717-3","article-title":"Cost-utility analyses of intensive blood glucose and tight blood pressure control in type 2 diabetes (UKPDS 72)","volume":"48","author":"Clarke","year":"2005","journal-title":"Diabetologia"},{"key":"B11","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1056\/NEJM199107183250302","article-title":"Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus","volume":"325","author":"Helmrich","year":"1991","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"107843","DOI":"10.1016\/j.diabres.2019.107843","article-title":"Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the international diabetes federation diabetes atlas, 9th edition","volume":"157","author":"Saeedi","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"key":"B13","doi-asserted-by":"publisher","first-page":"787135","DOI":"10.3389\/fpubh.2022.787135","article-title":"The cost-effectiveness of digital health interventions: a systematic review of the literature","volume":"10","author":"Gentili","year":"2022","journal-title":"Front Public Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1038\/s41746-020-00330-2","article-title":"WHO digital health guidelines: a milestone for global health","volume":"3","author":"Labrique","year":"2020","journal-title":"NPJ Digit Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1007\/s10729-018-9458-2","article-title":"The value of mHealth for managing chronic conditions","volume":"23","author":"Agnihothri","year":"2020","journal-title":"Health Care Manag Sci"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e44132","DOI":"10.2196\/44132","article-title":"Effectiveness of digital health interventions containing game components for the self-management of type 2 diabetes: systematic review","volume":"11","author":"Ossenbrink","year":"2023","journal-title":"JMIR Serious Games"},{"key":"B17","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1177\/193229681300700322","article-title":"Outcomes of a 12-month technology-based intervention to promote weight loss in adolescents at risk for type 2 diabetes","volume":"7","author":"Patrick","year":"2013","journal-title":"J Diabetes Sci Technol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e17536","DOI":"10.2196\/17536","article-title":"Feasibility of a digital health intervention to improve diet quality among women with high blood pressure: randomized controlled feasibility trial","volume":"8","author":"Steinberg","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e0170581","DOI":"10.1371\/journal.pone.0170581","article-title":"What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions","volume":"12","author":"Iribarren","year":"2017","journal-title":"PLoS One"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e122","DOI":"10.2196\/jmir.8954","article-title":"Physical activity, sedentary behavior, and diet-related eHealth and mHealth research: bibliometric analysis","volume":"20","author":"M\u00fcller","year":"2018","journal-title":"J Med Internet Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s12966-016-0434-2","article-title":"The effectiveness of e-& mHealth interventions to promote physical activity and healthy diets in developing countries: a systematic review","volume":"13","author":"M\u00fcller","year":"2016","journal-title":"Int J Behav Nutr Phys Act"},{"key":"B22","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/1479-5868-9-52","article-title":"Meta-analysis of internet-delivered interventions to increase physical activity levels","volume":"9","author":"Davies","year":"2012","journal-title":"Int J Behav Nutr Phys Act"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e12053","DOI":"10.2196\/12053","article-title":"Can smartphone apps increase physical activity? Systematic review and meta-analysis","volume":"21","author":"Romeo","year":"2019","journal-title":"J Med Internet Res"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e253","DOI":"10.2196\/jmir.4836","article-title":"Mobile phone apps to promote weight loss and increase physical activity: a systematic review and meta-analysis","volume":"17","author":"Flores Mateo","year":"2015","journal-title":"J Med Internet Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.jclinepi.2021.02.003","article-title":"Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement","volume":"134","author":"Page","year":"2021","journal-title":"J Clin Epidemiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e298","DOI":"10.2196\/jmir.9609","article-title":"Web-based digital health interventions for weight loss and lifestyle habit changes in overweight and obese adults: systematic review and meta-analysis","volume":"21","author":"Beleigoli","year":"2019","journal-title":"J Med Internet Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.diabres.2017.06.016","article-title":"Usability and clinical efficacy of diabetes mobile applications for adults with type 2 diabetes: a systematic review","volume":"131","author":"Fu","year":"2017","journal-title":"Diabetes Res Clin Pract"},{"key":"B29","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1016\/j.pcd.2019.09.007","article-title":"Effectiveness of short message service intervention to improve glycated hemoglobin control and medication adherence in type-2 diabetes: a meta-analysis of prospective studies","volume":"14","author":"Zhuang","year":"2020","journal-title":"Prim Care Diabetes"},{"key":"B30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/jhn.12207","article-title":"A systematic review and meta-analysis of interventions for weight management using text messaging","volume":"28","author":"Siopis","year":"2015","journal-title":"J Hum Nutr Diet"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e25138","DOI":"10.2196\/25138","article-title":"Mobile and wearable technology for the monitoring of diabetes-related parameters: systematic review","volume":"9","author":"Rodriguez-Le\u00f3n","year":"2021","journal-title":"JMIR Mhealth Uhealth"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e15","DOI":"10.2196\/diabetes.8645","article-title":"Improved diabetes care management through a text-message intervention for low-income patients: mixed-methods pilot study","volume":"3","author":"Watterson","year":"2018","journal-title":"JMIR Diabetes"},{"key":"B33","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1089\/tmj.2006.0089","article-title":"Exploring challenges and potentials of personal health records in diabetes self-management: implementation and initial assessment","volume":"13","author":"Hess","year":"2007","journal-title":"Telemed J e-health"},{"key":"B34","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1089\/tmj.2014.0053","article-title":"Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review","volume":"21","author":"de la Torre-D\u00edez","year":"2015","journal-title":"Telemed J e-health"},{"key":"B35","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1197\/jamia.M1672","article-title":"Use of e-health services between 1999 and 2002: a growing digital divide","volume":"12","author":"Hsu","year":"2005","journal-title":"J Am Med Inf Assoc"},{"key":"B36","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s11606-008-0899-z","article-title":"Patient use of secure electronic messaging within a shared medical record: a cross-sectional study","volume":"24","author":"Ralston","year":"2009","journal-title":"J Gen Intern Med"},{"key":"B37","doi-asserted-by":"publisher","first-page":"e22201","DOI":"10.2196\/22201","article-title":"Promotion of physical activity in older people using mHealth and eHealth technologies: rapid review of reviews","volume":"22","author":"McGarrigle","year":"2020","journal-title":"J Med Internet Res"},{"key":"B38","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1177\/1084822305281949","article-title":"Redesigning a telehealth diabetes management program for a digital divide seniors population","volume":"18","author":"Kaufman","year":"2006","journal-title":"Home Health Care Manag Pract"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e125","DOI":"10.1016\/S2589-7500(22)00233-3","article-title":"Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials","volume":"5","author":"Moschonis","year":"2023","journal-title":"Lancet Digit Health"},{"key":"B40","doi-asserted-by":"publisher","first-page":"e14506","DOI":"10.14814\/phy2.14506","article-title":"Impact of interval walking training managed through smart mobile devices on albuminuria and leptin\/adiponectin ratio in patients with type 2 diabetes","volume":"8","author":"Sokolovska","year":"2020","journal-title":"Physiol Rep"},{"key":"B41","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1515\/hmbci-2013-0053","article-title":"The role of leptin\/adiponectin ratio in metabolic syndrome and diabetes","volume":"18","author":"L\u00f3pez-Jaramillo","year":"2014","journal-title":"Horm Mol Biol Clin Investig"},{"key":"B42","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1210\/jc.2005-1803","article-title":"Limitation of the homeostasis model assessment to predict insulin resistance and beta-cell dysfunction in older people","volume":"91","author":"Chang","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"B43","doi-asserted-by":"publisher","first-page":"320","DOI":"10.3803\/EnM.2016.31.2.320","article-title":"C-peptide-based index is more related to incident type 2 diabetes in non-diabetic subjects than insulin-based index","volume":"31","author":"Kim","year":"2016","journal-title":"Endocrinol Metab (Seoul, Korea)"},{"key":"B44","doi-asserted-by":"publisher","first-page":"20552076221089778","DOI":"10.1177\/20552076221089778","article-title":"Digital tools to support the maintenance of physical activity in people with long-term conditions: a scoping review","volume":"8","author":"Clarkson","year":"2022","journal-title":"Digital Health"},{"key":"B45","doi-asserted-by":"publisher","first-page":"e46439","DOI":"10.2196\/46439","article-title":"Benefits and harms of digital health interventions promoting physical activity in people with chronic conditions: systematic review and meta-analysis","volume":"25","author":"Zangger","year":"2023","journal-title":"J Med Internet Res"},{"key":"B46","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1007\/s00125-008-1012-1","article-title":"Impaired stroke volume and aerobic capacity in female adolescents with type 1 and type 2 diabetes mellitus","volume":"51","author":"Gusso","year":"2008","journal-title":"Diabetologia"},{"key":"B47","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1093\/ageing\/afq147","article-title":"Lessened decline in physical activity and impairment of older adults with diabetes with telemedicine and pedometer use: results from the IDEATel study","volume":"40","author":"Weinstock","year":"2011","journal-title":"Age Ageing"},{"key":"B48","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1111\/j.1365-2753.2007.00881.x","article-title":"Evaluating the impact of mobile telephone technology on type 2 diabetic patients\u2019 self-management: the NICHE pilot study","volume":"14","author":"Faridi","year":"2008","journal-title":"J Eval Clin Pract"},{"key":"B49","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1177\/1932296818820303","article-title":"Behavioral theory: the missing ingredient for digital health tools to change behavior and increase adherence","volume":"13","author":"Klonoff","year":"2019","journal-title":"J Diabetes Sci Technol"},{"key":"B50","doi-asserted-by":"publisher","first-page":"e60","DOI":"10.2196\/jmir.1463","article-title":"Using evidence-based internet interventions to reduce health disparities worldwide","volume":"12","author":"Mu\u00f1oz","year":"2010","journal-title":"J Med Internet Res"},{"key":"B51","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/S0167-6296(02)00126-1","article-title":"The price of innovation: new estimates of drug development costs","volume":"22","author":"DiMasi","year":"2003","journal-title":"J Health Econ"},{"key":"B52","doi-asserted-by":"publisher","first-page":"108084","DOI":"10.1016\/j.diabres.2020.108084","article-title":"Cost and cost-effectiveness of mHealth interventions for the prevention and control of type 2 diabetes mellitus: a systematic review","volume":"162","author":"Rinaldi","year":"2020","journal-title":"Diabetes Res Clin Pract"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1630588\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T12:51:13Z","timestamp":1753793473000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1630588\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,29]]},"references-count":52,"alternative-id":["10.3389\/fdgth.2025.1630588"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2025.1630588","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,29]]},"article-number":"1630588"}}