Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul;16(4):812-824.
doi: 10.1177/19322968211036430. Epub 2021 Aug 11.

A New Taxonomy for Technology-Enabled Diabetes Self-Management Interventions: Results of an Umbrella Review

Deborah A Greenwood  1 , Michelle L Litchman  2 , Diana Isaacs  3 , Julia E Blanchette  2 , Jane K Dickinson  4 , Allyson Hughes  5 , Vanessa D Colicchio  2 , Jiancheng Ye  6 , Kirsten Yehl  7 , Andrew Todd  8 , Malinda M Peeples  9
Affiliations

A New Taxonomy for Technology-Enabled Diabetes Self-Management Interventions: Results of an Umbrella Review

Deborah A Greenwood et al. J Diabetes Sci Technol. 2022 Jul.

Abstract

Background: A 2017 umbrella review defined the technology-enabled self-management (TES) feedback loop associated with a significant reduction in A1C. The purpose of this 2021 review was to develop a taxonomy of intervention attributes in technology-enabled interventions; review recent, high-quality systematic reviews and meta-analyses to determine if the TES framework was described and if elements contribute to improved diabetes outcomes; and to identify gaps in the literature.

Methods: We identified key technology attributes needed to describe the active ingredients of TES interventions. We searched multiple databases for English language reviews published between April 2017 and April 2020, focused on PwD (population) receiving diabetes care and education (intervention) using technology-enabled self-management (comparator) in a randomized controlled trial, that impact glycemic, behavioral/psychosocial, and other diabetes self-management outcomes. AMSTAR-2 guidelines were used to assess 50 studies for methodological quality including risk of bias.

Results: The TES Taxonomy was developed to standardize the description of technology-enabled interventions; and ensure research uses the taxonomy for replication and evaluation. Of the 26 included reviews, most evaluated smartphones, mobile applications, texting, internet, and telehealth. Twenty-one meta-analyses with the TES feedback loop significantly lowered A1C.

Conclusions: Technology-enabled diabetes self-management interventions continue to be associated with improved clinical outcomes. The ongoing rapid adoption and engagement of technology makes it important to focus on uniform measures for behavioral/psychosocial outcomes to highlight healthy coping. Using the TES Taxonomy as a standard approach to describe technology-enabled interventions will support understanding of the impact technology has on diabetes outcomes.

Keywords: A1C; diabetes care and education; diabetes self-management education and support; taxonomy; technology-enabled self-management; umbrella review.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Deborah Greenwood is an employee of Dexcom Corporation and faculty for Lifescan Diabetes Institute, consultant for Lifescan, and Silverfern; Digital health advisory board, Novo Nordisk.

Michelle L. Litchman was the PI of an investigator-initiated trial funded by Abbott Diabetes Care unrelated to this study.

Julia E. Blanchette is a consultant for WellDoc, Inc; a consultant/independent contractor for Insulet Corporation and Tandem Diabetes; Advisory Board for Cardinal Health and Provention Bio; Research Support from the Association of Diabetes Care and Education Specialists and the Certification Board for Diabetes Care and Education unrelated to this study.

Jane K. Dickinson has no relevant disclosures.

Allyson S. Hughes has no relevant disclosures.

Jiancheng Ye has no relevant disclosures.

Kirsten Yehl is on staff at the Association of Diabetes Care & Education Specialists.

Andrew Todd has no relevant disclosures

Malinda Peeples is an employee of Welldoc, Inc.

Diana Isaacs serves on the speaker’s bureau for Dexcom, Abbott, Medtronic, Novo Nordisk and a consultant for Lifescan. She has served on Advisory Boards for Medtronic, Lilly, and Prevention Bio.

Vanessa D. Colicchio is a full-time PhD candidate at the University of Utah College of Nursing and has no relevant disclosures.

Figures

Figure 1.
Figure 1.
Taxonomy definitions applied to exemplar studies.
Figure 2.
Figure 2.
PRISMA flow diagram 2009.
See this image and copyright information in PMC

References

    1. Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. J Diabetes Sci Technol. 2017;11(5):1015-1027. doi:10.1177/1932296817713506 - DOI - PMC - PubMed
    1. Whittemore R, Siverly L, Wischik DL, Whitehouse CR. An umbrella review of text message programs for adults with type 2 diabetes. Diabetes Educ. 2020;46(6):514-526. doi:10.1177/0145721720965464 - DOI - PubMed
    1. Timpel P, Oswald S, Schwarz PEH, Harst L. Mapping the evidence on the effectiveness of telemedicine interventions in diabetes, dyslipidemia, and hypertension: an umbrella review of systematic reviews and meta-analyses. J Med Internet Res. 2020;22(3):e16791. doi:10.2196/16791 - DOI - PMC - PubMed
    1. Levine BJ, Close KL, Gabbay RA., Reviewing U.S. connected diabetes care: the newest member of the team. Diabetes Technol Ther. 2020;22:1-9. doi:10.1089/dia.2019.0273 - DOI - PubMed
    1. Association of Diabetes Care and Education Specialists, Association of Diabetes Care, Association of Diabetes Care, Kolb L. An effective model of diabetes care and education: the ADCES7 self-care behaviors™. Sci Diabetes Self Manag Care. 2021;47(1):30-53. doi:10.1177/0145721720978154 - DOI - PubMed

Publication types

Substances