The Effectiveness of Long-Term Support with Digital Health Interventions in Adults with Prediabetes: A Systematic Review

Abstract

Background Type 2 diabetes mellitus (T2DM) is a growing global health concern, with prediabetes serving as a critical warning stage. Without timely intervention, individuals with prediabetes face a high risk of progressing to T2DM, leading to severe complications and economic burdens. While lifestyle interventions are effective in reducing this risk, their long-term sustainability remains a challenge. Digital health interventions (DHIs), including mobile applications, telehealth platforms, and wearable monitoring devices, have emerged as innovative tools to provide continuous support for behaviour modification and glycaemic control. Objectives This systematic review aims to evaluate the effectiveness of long term digital health interventions (≥12 months) in improving glycaemic control (HbA1c reduction) among adults with prediabetes. Additionally, it examines the impact of DHIs on weight management as a secondary outcome, comparing their effectiveness to standard or non-digital healthcare interventions. Study Design A comprehensive literature search was conducted across several databases including MEDLINE, Embase, Scopus, and CINAHL following PRISMA guidelines. Studies were screened based on predefined inclusion and exclusion criteria, with a focus on randomised controlled trials (RCTs) evaluating the effects of DHIs over a minimum of 12 months. The quality of the included studies was assessed using the JBI Critical Appraisal Checklist. Results In total, six RCTs met the inclusion criteria, demonstrating that DHIs significantly contribute to improved glycaemic control and weight management. Studies reported reductions in HbA1c levels among DHI users compared to standard care, with sustained metabolic benefits observed over the 12-month period. Weight loss outcomes varied, but digital interventions incorporating self-monitoring, real time feedback, and remote coaching showed higher adherence rates and long-term weight maintenance. Despite these benefits, limitations such as digital literacy disparities, participant adherence variability, and the absence of participant blinding in behavioural interventions were identified as challenges impacting the effectiveness of DHIs. Conclusion The findings highlight the potential of long term DHIs as scalable and cost-effective solutions for diabetes prevention. By providing continuous support and personalised health tracking, DHIs enhance adherence to lifestyle modifications and improve long term glycaemic outcomes. However, further research is needed to explore their sustained impact beyond 12 months and to develop inclusive strategies addressing accessibility and adherence challenges. Integrating DHIs into public health policies may offer a viable approach to mitigating the growing burden of T2DM.