Effects of Ecological Momentary Interventions on Glycated Hemoglobin, Body Mass Index, and Quality of Life in People with Type 2 Diabetes: A Review

Summary

This systematic review and meta-analysis evaluate the effectiveness of ecological momentary interventions on glycemic control, weight management, and quality of life in people with type 2 diabetes.

Abstract

The global prevalence of type 2 diabetes mellitus (T2DM) continues to rise. Effective blood glucose and weight management are crucial for disease control and improving quality of life. Ecological momentary interventions (EMIs), which provide real-time personalized support based on ecological momentary assessments (EMAs) of relevant variables, offer a promising approach to promote adaptive self-management in daily life. We systematically searched five databases from inception to August 2025. Primary outcomes included glycated hemoglobin (HbA1c) and body mass index (BMI); secondary outcomes covered physical and mental health-related quality of life (HRQoL). Fourteen studies, including a total of 1,873 participants, were included. Compared to controls, EMIs significantly reduced HbA1c (MD = -0.71, 95% CI: -1.02 to -0.40, p < 0.001) and BMI (MD = -1.08, 95% CI: -1.90 to -0.26, p = 0.01), with substantial between-study heterogeneity (I² = 84% and 92%, respectively). Subgroup analyses showed more consistent effects for multi-domain comprehensive EMIs, while the effects of single-domain EMIs varied depending on the intervention content. EMIs were also associated with modest improvements in physical (SMD = 0.37, 95% CI: 0.17 to 0.56, p < 0.001; I² = 47%) and mental (SMD = 0.42, 95% CI: 0.15 to 0.68, p = 0.002; I² = 0%) HRQoL. These findings suggest that EMIs, especially multi-domain comprehensive strategies, appear to be a promising intervention for T2DM management, yet the overall certainty of current evidence is limited by marked heterogeneity, restricted statistical power in subgroups, and some risk of bias, warranting cautious interpretation of the results. Future research should prioritize high-quality designs and comprehensive outcome assessments.

Introduction

It is estimated that there were approximately 589 million people with diabetes worldwide in 2024, and this number is projected to rise to 853 million by 2050¹. Type 2 diabetes mellitus (T2DM) accounts for about 90–95% of all diabetes cases, while diabetes imposes an annual economic burden of nearly 1.015 trillion US dollars globally², placing substantial pressure on healthcare systems worldwide³. Effective blood glucose management is essential to reduce the disease burden of T2DM and improve the quality of life among people with T2DM. Notably, over 60% of individuals with T2DM also have over....

Protocol

The systematic review and meta-analysis were conducted following the PRISMA guidelines (Supplementary Table 1)²⁷. The protocol for this review was registered in PROSPERO: No. CRD420251132100.

1. Search strategy

1. Database selection: Perform a systematic approach across five major electronic databases: PubMed, Cochrane Library, Embase, Web of Science, and Scopus. Ensure the search encompasses all records from database inception until August 2025.
2. Search term development: Utilize a combination of medical subject headings (MeSH) terms and free-text keywords. Include ....

Results

Study selection
After comprehensive searches across various databases, 2,691 articles were identified. Following the removal of duplicate records (n = 633), 2,058 remaining records were checked for titles and abstracts, and 2,029 were removed. We downloaded 29 full-text articles during the final screening and a more detailed investigation. Ultimately, only 14 articles satisfied the predetermined criteria (Figure 1).

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Discussion

This systematic review and meta-analysis of 14 studies aimed to evaluate the effectiveness of EMIs in the management of T2DM (Supplementary Table 4). The results indicate that EMIs significantly reduced HbA1c and BMI. Nevertheless, considerable heterogeneity was observed across studies, and subgroup analyses confirmed that intervention components were a key source of heterogeneity. Multi-domain comprehensive EMIs appear more beneficial for glycemic and BMI control, whereas among single-domain EMIs, the e.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
EndNote X9	Clarivate	Official Version	This software was utilized for managing bibliographic records and removing duplicate citations identified through the systematic database searches. It facilitated the initial organization of references prior to the screening process.
Review Manager 5.3 (RevMan 5.3)	The Cochrane Collaboration	Official Version	This program served as the primary tool for conducting the meta-analysis. It was used to perform all statistical calculations, generate forest plots for outcome analyses, and create risk of bias figures.
Microsoft Excel	Microsoft	Official Version	A standardized data extraction form was created in this spreadsheet software. It was used to systematically collect and tabulate relevant data from each of the included primary studies.