Umbrella review of systematic reviews analyzing the effectiveness of digital tools in improving medication adherence among diabetic patients

Document Type

Review

Publication Date

1-1-2026

Abstract

Introduction: Poor medication adherence is a prevalent issue among diabetic patients, significantly impacting glycemic control and increasing the risk of complications. Digital interventions, such as mobile apps, SMS reminders, and telehealth, have emerged as innovative tools to improve adherence. Aim: This umbrella review aimed to synthesize evidence from published systematic reviews evaluating the effectiveness of digital tools used for improving medication adherence among diabetic patients. Methods: A comprehensive search of major databases including PubMed, Google Scholar, and EBSCOhost was conducted to identify systematic reviews assessing digital interventions for medication adherence in diabetes based on predefined inclusion criteria. AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) were used to evaluate the methodological quality and evidence strength, respectively. Results: This umbrella review systematically evaluated 13 systematic reviews comprising 79 unique randomized controlled trials (RCTs). Mobile apps demonstrated a statistically significant improvement in medication adherence (standard mean deviation [SMD] = 0.47; 95% confidence interval [CI] 0.30 to 0.64), highlighting their effectiveness through features such as reminders, educational content, and real-time feedback. SMS reminders showed robust results, with a moderate to large improvement in adherence (SMD = 0.57; 95% CI -0.94 to 2.08), emphasizing their practicality and scalability, especially in resource-limited settings. Telehealth interventions exhibited a smaller, non-statistically significant improvement in adherence (SMD = 0.17; 95% CI −0.51 to 0.84), with variability attributed to differences in implementation and patient engagement. High heterogeneity (I2 = 77.5%) was observed, reflecting variations in study designs, populations, and intervention protocols. Conclusion: Digital interventions, particularly mobile applications and SMS reminders, are effective strategies for improving medication adherence among diabetic patients. However, variability in intervention designs and methodological limitations highlight the need for high-quality large-scale trials.

Publication Title

Journal of Public Health Germany

ISSN

21981833

DOI

10.1007/s10389-026-02716-0

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