Effect of digital health interventions on glycaemic control among type 2 diabetes individuals in low and middle-income countries: a systematic review and meta-analysis

Type 2 diabetes mellitus (T2DM) poses a significant public health challenge, particularly in Low- and middle-income countries (LMICs), where access to continuous Diabetes self-management (DSM) is limited. Digital Health Interventions (DHI) have emerged as promising tools to enhance DSM by facilitating self-monitoring and promoting health-promoting behaviours. This systematic review aimed to evaluate the effectiveness of DHIs in improving glycaemic control and their impact on health-promoting behaviours among individuals with T2DM in LMICs.

A systematic review and meta-analysis of RCTs published between 2016 and 2025 was conducted to evaluate the effectiveness of DHI in managing blood glucose levels among individuals with T2DM aged ≥ 18 years. Databases such as PubMed, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) were used for the search. Continuous outcomes were analysed using a random-effects model and reported as mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias (ROB) was assessed using the Cochrane RoB 2 tool, and all analyses were performed in Review Manager (RevMan) version 5.4.

DHI demonstrated a significant improvement in glycaemic control across 15 of the total 23 included studies, with a reduction in HbA1c levels [MD: -0.58 (95% CI: -0.83, -0.33), P < 0.0001, I² =98%]. Subgroup analysis conducted on the duration of intervention on HbA1c showed significant results at 3months [MD: -0.54 (95% CI: -0.85, -0.23), P = 0.0006, I² = 88%] and ≥ 12 months [MD: -0.45 (95% CI: -0.63, -0.27), P < 0.00001, I² = 93%]. Significant changes were observed in the subgroup analysis of the type of interventions and secondary outcomes assessed, such as Fasting Blood Glucose (FBG), Low-density lipoproteins (LDL), and Triglyceride (TG).

The findings of this systematic review indicate that DHI can significantly improve glycaemic control among individuals with T2DM. mHealth applications and SMS reminders, as well as video-based interventions, can significantly improve health outcomes for individuals with T2DM. These digital tools support better self-management by promoting medication adherence, encouraging healthy lifestyle behaviours, and providing accessible education and motivation. SMS reminders help patients stay consistent with treatment plans and monitoring routines, while video interventions offer engaging and easy-to-understand guidance on diabetes care. The technologies also enhance patient engagement by improving glycaemic control and contribute to overall DSM.