Diabetes is one of the commonest long-term medical conditions, affecting around 347 million adults worldwide. Around 90% of them have type 2 diabetes and are at significant risk of developing diabetes related complications such as strokes or heart attacks. Patient education programmes can reduce the risk of diabetes-related complications, but many people with type 2 diabetes have never attended structured education programmes to learn how to look after themselves (self-management). Better use of computers might be one way of helping more people learn about self-management.
We identified 16 trials involving 3578 adults that met our criteria. These studies included different types of interventions used in different places like touch screen computers in hospital clinics, computers connected to the Internet at home and programmes that communicated with mobile phones. The average age of people taking part was between 46 to 67 years old and most of those people had lived with diabetes for 6 to 13 years. Participants were given access to the interventions for 1 to 12 months, depending on the intervention. Three out of the 3578 participants died but these deaths did not appear to be linked to the trials.
Overall, there is evidence that computer programmes have a small beneficial effect on blood sugar control - the estimated improvement in glycosylated haemoglobin A1c (HbA1c - a long-term measurement of metabolic control) was 2.3 mmol/mol or 0.2%. This was slightly higher when we looked at studies that used mobile phones to deliver their intervention - the estimated improvement in HbA1c was 5.5 mmol/mol or 0.5% in the studies that used mobile phones. Some of the programmes lowered cholesterol slightly. None of the programmes helped with weight loss or coping with depression.
One participant withdrew because of anxiety but there were no obvious side effects and hypoglycaemic episodes were not reported in any of the studies. There was very little information about costs or value for money.
In summary, existing computer programmes to help adults self-manage type 2 diabetes appear to have a small positive effect on blood sugar control and the mobile phone interventions appeared to have larger effects. There is no evidence to show that current programmes can help with weight loss, depression or improving health-related quality of life but they do appear to be safe.