Effectiveness of Lifestyle Interventions Based on Diet, Physical Activity, and Digital Technology in the Prevention and Management of Type 2 Diabetes Complications: A Systematic Review
DOI:
https://doi.org/10.37287/ijghr.v8i4.1103Keywords:
cardiovascular disease, digital health technology, HbA1c, lifestyle intervention, type 2 diabetes mellitusAbstract
Type 2 Diabetes Mellitus (T2DM) requires comprehensive lifestyle management to prevent life-threatening microvascular and macrovascular complications. Although diet and physical activity are the main pillars, the integration of digital technology offers new potential for improving compliance and clinical outcomes. Objective: This systematic review aims to synthesize evidence on the effectiveness of multidomain lifestyle interventions (diet, physical activity, digital technology) on glycemic control, cardiovascular complication risk, and quality of life in T2DM patients. A systematic literature search was conducted in PubMed, Scopus, and SAGE Journals databases for English and Indonesian articles published between 2020 and 2025. Study selection followed the PRISMA 2020 guidelines, using the Search String pumped ("Diabetes Mellitus, Type 2"[MeSH] OR "T2DM" OR "prediabetes") AND ("Life Style"[MeSH] OR "diet" OR "physical activity" OR "exercise") AND ("Telemedicine"[MeSH] OR "mobile app" OR "digital health") AND ("Randomized Controlled Trial" OR "Cohort Study". Search String Scopus TITLE-ABS-KEY(("Diabetes Mellitus, Type 2" OR "T2DM") AND ("Life Style" OR "diet" OR "exercise") AND ("digital health" OR "mobile app") AND ("RCT" OR "Cohort")). Search String sage journal ("Type 2 Diabetes” OR "T2DM") AND ("Lifestyle" OR "Diet" OR "Physical Activity") AND ("Digital Health" OR "App). Methodological quality was assessed using the Joanna Briggs Institute (JBI) instrument. Due to high clinical heterogeneity, data were synthesized narratively. A total of 20 studies (17 RCTs and 3 Prospective Cohort Studies; N > 50,000) met the inclusion criteria. Low-carbohydrate and plant-based dietary interventions significantly reduced HbA1c with Mean Differences (MD) ranging from -0.5% to -1.3% and supported diabetes remission (NNT=5.3). The combination of aerobic and resistance physical activity reduced inflammatory markers and improved insulin sensitivity. Digital technology-based interventions (apps/CGM) recorded an average HbA1c reduction of -0.4% to -1.8% (p<0.01) and increased Time-in-Range (+31 minutes/day). Long-term evidence shows that combined lifestyle interventions reduce cardiovascular mortality (Hazard Ratio [HR] 0.54; 95% CI 0.3–0.9) and diabetes incidence (HR 0.76) over a 20–30-year follow-up period. The combination of dietary modification, structured physical activity, and digital technology provides superior clinical effectiveness compared to single interventions. Despite limitations such as heterogeneity in intervention duration, the evidence supports the integration of hybrid (digital-physical) care models into standard nursing practice for the prevention of long-term complications.
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