Diabetes

  • Systematic reviews and meta-analyses suggest benefits (one large systematic review indicated reduction in A1c of 0.5 over 6 mos) but the magnitude varies & studies are heterogenous
  • While 17 studies were included, there were important gaps like not reporting changes in medication, actual uptake/use of technology, and details on the interventions (eg how many texts were actually sent).
  • Studies often used multiple types of technology and more intensive management than usual care (eg frequent nurse calls), so difficult to assess additional benefits of specific technology.

Hypertension

  • Existing systematic reviews & meta-analyses suggest reduction in SBP by ~2-8 mm Hg (depending on analyses).
  • Unclear what the best techniques and technology are, based on available evidence, but interventions using multiple techniques that are effective with in-person counseling are probably better (goal setting, self-monitoring, problem solving).

Dyslipidemia

  • The amount of evidence here is “surprisingly low.” Only three studies made the cut for inclusion.
  • Noted some promising studies using web-based + text-messaging intervention as well as a smartphone-connected device for measuring serum cholesterol.

There were several themes that emerged in the document: studies were often small, follow-up often short, interventions often complex and mulitmodal in comparison to the control, and participants populations are limited.

In their suggestions for future research, the panel does a nice job of making practical suggestions for the improvement of digital health tools in each area. For example, in hypertension they suggest using what we know about in-person counseling and more systematically transferring that to digital health interventions.

Overall, this statement is an incredibly timely overview of the state of digital health research in these areas and the gaps in knowledge that need to be filled to allow us to use this technology to really impact outcomes. We’ve really just touched on a few of the highlights here; for anyone interested in developing an app or device for any of these areas, researcher or developer, this scientific statement should be required reading.