Background/Objective: Type 2 Diabetes Mellitus (T2DM) represents a major increasing burden for primary care systems worldwide. Digital health interventions (DHIs) have been proposed as scalable tools to improve glycemic control, yet uncertainty remains regarding which intervention characteristics yield the greatest benefit. To evaluate the effectiveness of DHIs on HbA1c levels in adults with T2DM and to examine whether intervention duration, engagement intensity, glucometer integration, and healthcare provider involvement modify glycemic outcomes. Data Sources: PubMed, Embase, Cochrane Library, and JMIR databases were systematically searched for relevant studies published between January 2020 and May 2025. Study Eligibility Criteria: Randomized controlled trials comparing DHIs plus usual care versus usual care alone in adults with T2DM and reporting HbA1c as the primary outcome. Methods: Data were extracted using the Jadad scale and TIDieR framework. Random-effects meta-analysis estimated pooled mean differences (MD) in HbA1c with 95% CIs. Subgroup analyses examined effects by intervention characteristics. Heterogeneity and sources of variance were assessed through Cochran’s Q, I², meta-regression, and sensitivity analyses (leave-one-out and trim-and-fill). Results: Thirteen RCTs (n ≈ 20,000) met inclusion criteria. DHIs achieved significant HbA1c reductions (range 0.01% to 1.57%; pooled MD −1.08%; 95% CI −1.18 to −0.99; p = 0.001). Short-term (≤6 months), low-intensity interventions showed the largest effect sizes (MD −1.16%, 95% CI 0.94 to 1.39). Glucometer integration and healthcare provider involvement contributed minimally to additional benefit. Meta-regression confirmed substantial heterogeneity, but no single factor explained variance across studies. Limitations: Considerable heterogeneity across interventions and variability in engagement measurement may limit the generalizability of findings. Conclusions: Short-term, low-intensity DHIs significantly improve glycemic control in primary care populations with T2DM. Advanced meta-analytic techniques confirm the robustness of these effects, providing practical guidance for selecting and implementing effective digital interventions in routine diabetes care.

Background/Objectives: The Adhera^® Caring Digital Program (ACDP) is a digitally delivered intervention aimed at enhancing the mental and physical well-being of family caregivers of children with chronic conditions. Tailored for the context of childhood obesity, ACDP leverages the Adhera AI Precision Digital Companion to support caregivers in promoting effective treatment adherence and healthy behaviors at home. While children in this study received GLP-1 receptor agonist treatment as part of their obesity management, the ACDP was designed to empower caregivers through educational, behavioral, and emotional support tools. The aim of this study was to determine the relationship between engagement with the ACDP as a DHI and clinical outcomes in participants receiving GLP-1 receptor agonist treatment for obesity. Methods: This study analyzed data from approximately 40 pediatric patients receiving GLP-1-based pharmacological treatment for obesity and their caregivers enrolled in the ACDP. Caregiver engagement was assessed through a composite score derived from digital activity metrics and classified as low, medium, or high. Children’s clinical parameters (BMI, weight, fat mass %, muscle mass %, and waist circumference) were collected at baseline and Day 150. Biometric, physical activity, and sleep data were also collected through a wearable device, enabling continuous and objective monitoring of participants’ physiological and behavioral patterns in real-world conditions. Statistical analyses included paired comparisons, Pearson correlations, and group comparisons by engagement level. Results: Data from 40 pediatric participants and their caregivers were analyzed over 150 days. Observed changes over the time in children showed a reduction in waist circumference (−6.0%, p = 0.0056) and a modest decrease in BMI. Higher levels of caregiver engagement with the Adhera^® Caring Digital Program correlated with reduction in body fat (ΔFat% r ≈ 0.5, p = 0.091) representing the strongest correlation observed in the study, albeit not reaching statistical significance. From baseline to Day 150, significant improvements were observed across all clinical outcomes, including reductions in BMI (−4.51 kg/m²), body weight (−11.42 kg), body fat percentage (−5.63%), and waist circumference (−8.69 cm), alongside an increase in muscle mass (+4.47%) (all p < 0.0001). Conclusions: At the mid-point of the intervention, combined GLP-1 pharmacotherapy and the Adhera^® Caring Digital Program led to meaningful improvements in BMI, adiposity, and central obesity. While caregiver engagement was not significantly associated with short-term outcomes, observed trends suggest that digital support may provide complementary benefits to pharmacological treatment, warranting further evaluation at Day 300.

BACKGROUND The Adhera® Caring Digital Program (ACDP) is a digitally delivered, family-centered intervention originally developed to support families of children with chronic conditions and subsequently adapted for pediatric growth hormone deficiency (GHD). OBJECTIVE This study evaluated, over a 90-day period, the effects of combining pharmacological treatment, objective adherence monitoring through a connected injection device, and the adapted digital program on treatment adherence, growth-related outcomes and caregiver-reported psychosocial measures. Besides we examined usability of the ACDP and engagement with the program. METHODS Baseline and day-90 outcomes were compared using t-test and Wilcoxon tests. RESULTS Favorable changes were observed in height SDS, growth velocity, and growth velocity SDS. BMI SDS improved, whereas absolute BMI showed no clear change; body weight increased, weight SDS remained stable. Caregiver-reported psychosocial outcomes also improved over time, with significant changes observed whereas engagement indicators showed positive, although non-significant, associations with adherence improvement. CONCLUSIONS In this 90-day prospective study, a family-centered digital health intervention (DHI) adapted for pediatric GHD, combined with pharmacological treatment and objective adherence monitoring, was associated with improved adherence, favorable short-term changes in growth-related outcomes, and improved caregiver-reported psychosocial outcomes. These findings support the potential value of integrated digital support in pediatric GHD management, although larger controlled studies are needed to confirm these findings and assess their generalizability. CLINICALTRIAL NCT06830525

Background: While mobile health (mHealth) interventions show promise for type 2 diabetes management, mechanisms linking user experience to clinical outcomes remain poorly understood. We hypothesized that perceived usability may mediate associations between patient characteristics and short-term clinical changes, with implications for health equity in digital interventions. Methods: Secondary analysis of the intervention arm from a randomized controlled trial in urban Mexican primary care (ClinicalTrials.gov NCT05924516). Participants used a diabetes self-management mobile application for 90 days. We assessed usability with the validated Computer System Usability Questionnaire (CSUQ; 16 items, 7-point scale) and measured clinical changes in body mass index (BMI), systolic blood pressure (SBP), and HbA1c. Bayesian mediation analysis (literature-informed priors) examined interface quality as a mediator of age-related clinical effects. Item-level analysis identified educational disparities in specific usability dimensions using independent t-tests adjusted for multiple comparisons. Results: Mean overall usability was 5.20/7 (SD = 0.89, 74th percentile). Interface quality mediated 39% of the age–SBP association. Participants experiencing high usability (≥6) versus low usability showed BMI reduction −0.78 vs. −0.21 kg/m² (Cohen’s d = 0.56) and SBP reduction −7.3 vs. −1.2 mmHg (Cohen’s d = 0.51). No mediation effect was observed for HbA1c change. Users with ≤primary education (41% of sample) scored 1.9 points lower on error messages (3.2 vs. 5.1, p < 0.01) and 1.4 points lower on help documentation (3.6 vs. 5.0, p < 0.03). These disparities persisted after controlling for age and baseline severity. Conclusions: Perceived usability was associated with a potential mechanistic pathway linking user experience to clinical outcomes. Higher usability scores were associated with clinically meaningful improvements in cardiometabolic parameters. Educational disparities in understanding error messages and helping documentation represent modifiable design barriers. Implementing contextual error explanations with visual examples and plain-language help content may enhance both clinical effectiveness and equity in digital diabetes interventions.