Effectiveness of app-based interventions for glucose management, cardiometabolic and mental health, and related risk factors: an umbrella review with meta-analysis.

Authors

Maria F Vasiloglou, Evangelia Kotzakioulafi, Fabio Mainardi, Mavra Ahmed, Amanda E Staiano, Eirini Dimidi, Marcel Salathé, Carol Maher, Corneel Vandelanotte, Christos S Mantzoros

Published in

The Lancet. Digital health. Pages 101009. Jul 21, 2026. Epub Jul 21, 2026.

Abstract

Non-communicable diseases are the leading cause of death globally. Smartphone apps can offer benefits for individuals, health-care professionals, and governments in the prevention and management of such conditions. We aimed to systematically evaluate the effectiveness of app-based interventions in improving the outcomes of non-communicable diseases and in modifying their metabolic and behavioural risk factors.
For this umbrella review and meta-analysis, we searched eight databases (Embase, Epistemonikos, IEEE Xplore Digital Library, APA PsycInfo via Ovid, PubMed, Scopus, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials) for systematic reviews with meta-analysis published between Jan 1, 2013, and Jan 10, 2024, with no restrictions by geographical location or language. Additional studies were located through citation chaining and searching of reference lists. Eligible studies reviewed randomised controlled trials or controlled studies focused on adults (aged ≥18 years) with or at risk of non-communicable diseases and the use of app-based interventions for managing or improving the outcomes of these diseases and related health and risk factors, both metabolic and behavioural. Two investigators (EK and MFV) used COVIDENCE software to screen abstracts and full texts and to subsequently extract data from eligible studies. In case of missing data, authors of the relevant articles were contacted for unreported data or additional details. Effect sizes were measured as the standardised mean difference (SMD) and were aggregated through meta-analyses. 95% CIs for each review were synthesised using a random-effects model and prediction intervals were based on a t distribution. When more than ten reviews were available, publication bias was assessed visually through the inspection of funnel plots and by Egger's test; if bias was suspected, a trim-and-fill analysis was applied to estimate a revised effect size. The quality of the included reviews was evaluated with the AMSTAR 2 checklist, the certainty of evidence for each outcome was assessed using the GRADE framework and the Ioannidis criteria, and heterogeneity was measured by calculating I² values. This study was registered with PROSPERO, CRD42023426735.
Of 6951 unique records identified by our searches, 383 underwent full-text review and 78 systematic reviews with meta-analysis, covering 31 outcomes, were included in the study. These reviews covered 496 primary studies and involved a total of 177 373 participants. App-based interventions were found to be effective in lowering diastolic blood pressure (SMD -0·414 [95% CI -0·606 to -0·221], I²=93%), systolic blood pressure (-0·444 [-0·689 to -0·199], I²=96%), glycated haemoglobin (-0·587 [-0·715 to -0·460], I²=91%), fasting blood glucose concentration (-1·189 [-1·605 to -0·774], I²=93%), 2 h postprandial glucose concentration (-1·229 [-1·609 to -0·848], I²=95%), anxiety (-0·215 [-0·407 to -0·023], I²=92%), depression (-0·097 [-0·176 to -0·019], I²=77%), stress (-0·336 [-0·528 to -0·143], I²=87%), bodyweight (-0·427 [-0·594 to -0·260], I²=91%), BMI (-0·265 [-0·522 to -0·007], I²=92%), waist circumference (-0·310 [-0·464 to -0·156], I²=75%), and sedentary time (-0·600 [-1·121 to -0·079], I²=22%). Additionally, apps significantly improve diet quality (0·551 [0·261-0·842], I²=91%), exercise capacity (0·259 [0·119-0·398], I²=17%), moderate-to-vigorous physical activity (0·240 [0·025-0·456], I²=75%), number of steps taken daily (0·489 [0·209-0·770], I²=83%), multiple physical activity outcomes (0·466 [0·243-0·689], I²=90%), mindfulness (0·293 [0·177-0·409], I²=77%), wellbeing (0·186 [0·065-0·307], I²=74%), quality of life (0·227 [0·083-0·371], I²=80%), and medication adherence (0·688 [0·410-0·965], I²=88%) when compared with control groups. However, no significant effect was found on cardiovascular mortality; HDL, LDL, total cholesterol, or triglyceride concentrations; body fat; distress; fruit and vegetable intake; hospitalisation; or smoking abstinence. Of the 78 systematic reviews, only one (1%) was rated as being of high quality, with three (4%) of moderate quality, 17 (22%) of low quality, and 57 (73%) of critically low quality. According to Ioannidis criteria, five outcomes were categorised as having highly suggestive (class II) evidence, with eight outcomes having suggestive evidence (class III), eleven outcomes having weak evidence, and seven outcomes categorised as non-significant.
Our analyses provide evidence that app-based interventions support significant improvements in multiple outcomes of and risk factors for non-communicable diseases, including cardiovascular diseases, glucose control, mental health outcomes, physical activity, and quality of life. The integration of app-based interventions into health-care systems should be prioritised to enhance patient care and health outcomes.
None.

PMID:
42481261
Bibliographic data and abstract were imported from PubMed on 22 Jul 2026.

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