Systematic review and evaluation of web-accessible tools for management of diabetes and related cardiovascular risk factors by patients and healthcare providers

Abstract

Objective: To identify and evaluate the effectiveness, clinical usefulness, sustainability, and usability of web-compatible diabetes-related tools.

Data sources: Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, world wide web.

Study selection: Studies were included if they described an electronic audiovisual tool used as a means to educate patients, care givers, or clinicians about diabetes management and assessed a psychological, behavioral, or clinical outcome.

Data extraction: Study abstraction and evaluation for clinical usefulness, sustainability, and usability were performed by two independent reviewers.

Results: Of 12,616 citations and 1541 full-text articles reviewed, 57 studies met inclusion criteria. Forty studies used experimental designs (25 randomized controlled trials, one controlled clinical trial, 14 before-after studies), and 17 used observational designs. Methodological quality and ratings for clinical usefulness and sustainability were variable, and there was a high prevalence of usability errors. Tools showed moderate but inconsistent effects on a variety of psychological and clinical outcomes including HbA1c and weight. Meta-regression of adequately reported studies (12 studies, 2731 participants) demonstrated that, although the interventions studied resulted in positive outcomes, this was not moderated by clinical usefulness nor usability.

Limitation: This review is limited by the number of accessible tools, exclusion of tools for mobile devices, study quality, and the use of non-validated scales.

Conclusion: Few tools were identified that met our criteria for effectiveness, usefulness, sustainability, and usability. Priority areas include identifying strategies to minimize website attrition and enabling patients and clinicians to make informed decisions about website choice by encouraging reporting of website quality indicators.

Figure 1

Published literature search algorithm. PRISMA flow diagram outlining results of published literature search and tool identification process.

Figure 2

Grey literature search algorithm. Modified PRISMA flow diagram outlining results of grey literature search and tool identification process.

Figure 3

(A) Modified forest plot demonstrating lack of moderating effect of clinical usefulness ratings on tool effectiveness. Squares with lines are the observed treatment effects and CI. Grey diamonds show the predicted treatment effects based on the model. (B) Modified forest plot demonstrating lack of moderating effect of usability ratings on tool effectiveness. Squares with lines are the observed treatment effects and CI. Grey diamonds show the predicted treatment effects based on the model.