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Health authorities recommend educating diabetic patients and their families and initiating measures aimed at improving self-management, promoting a positive behavior change, and reducing the risk of complications. Social media could provide valid channel to intervene in and deliver diabetes education. However, it is not well known whether the use of these channels in such interventions can help improve the patients’ outcomes.
The objective of our study was to review and describe the current existing evidence on the use of social media in interventions targeting people affected with diabetes.
A search was conducted across 4 databases (PubMed, Scopus, EMBASE, and Cochrane Library).The quality of the evidence of the included primary studies was graded according to the Grading of Recommendations Assessment, Development and Evaluation criteria, and the risk of bias of systematic reviews was assessed by drawing on AMSTAR (A MeaSurement Tool to Assess systematic Reviews) guidelines. The outcomes reported by these studies were extracted and analyzed.
We included 20 moderate- and high-quality studies in the review: 17 primary studies and 3 systematic reviews. Of the 16 publications evaluating the effect on glycated hemoglobin (HbA1c) of the interventions using social media, 13 reported significant reductions in HbA1c values. The 5 studies that measured satisfaction with the interventions using social media found positive effects. We found mixed evidence regarding the effect of interventions using social media on health-related quality of life (2 publications found positive effects and 3 found no differences) and on diabetes knowledge or empowerment (2 studies reported improvements and 2 reported no significant changes).
There is very little good-quality evidence on the use of social media in interventions aimed at helping people with diabetes. However, the use of these channels is mostly linked to benefits on patients’ outcomes. Public health institutions, clinicians, and other stakeholders who aim at improving the knowledge of diabetic patients could consider the use of social media in their interventions.
The prevalence of diabetes has been growing worldwide for the last few decades [
The use of social media has increased dramatically in the recent years [
Evidence on positive effects of social media interventions on health behavior-related outcomes (ie, weight loss and physical activity) exists in 2 meta-analyses focusing on several health conditions [
Norway is one of the most connected countries in the world, and most of the Norwegian population uses social media [
We performed a rapid review to quickly capture the current evidence on the use of social media in interventions on diabetes. We had two research questions: (1) Is there evidence on the use of social media in interventions aimed at improving, maintaining, or promoting health among people affected with diabetes? and (2) What are the reported outcomes, for example, the effects on clinical parameters, effects on behavior, or other effects?
The rapid review method was chosen as it typically provides similar conclusions as systematic reviews, and it allows to quickly and efficiently access the current evidence on the topic [
To answer the research questions, we performed an electronic search on February 13, 2018. It covered published studies comprising the terms “Social media,” “Social networking,” “Facebook,” “Twitter,” or “YouTube” in combination with the term “Diabetes” included in the title or abstract and indexed in the following databases: PubMed (Medical Subject Heading terms and text word), Scopus, EMBASE, and the Cochrane Library. The search strategy was limited to studies published in English. The full search strategy is summarized in
Publications were included in the review if they (1) focused on diabetes or involved participants affected by diabetes; (2) described interventions aimed at improving, maintaining, or promoting health; (3) reported results from the intervention; and (4) used social media in the intervention. Both primary studies and reviews were considered to be of interest and were, therefore, included in this review. Papers that did not meet all four criteria were excluded from the review.
All references captured by the search engine were uploaded to EndNote X7 (Clarivate Analytics; Philadelphia, PA, USA). Duplicates were identified and removed. To assess the eligibility of the papers, two passes were done. In the first pass, all titles and abstracts were examined by one reviewer (EG). In the second pass, the full text of the studies selected on the first pass was extracted and carefully analyzed to confirm their eligibility. When it was unclear whether the studies should be included, they were discussed and agreed with a second reviewer (EÅ). The agreed upon studies were included in the quality assessment. A single reviewer (EG) extracted the data from the included studies. The following data were extracted: interventions (duration and participants), social media use (channels, use as main tool for the intervention or as supporting tool), and outcomes (effects on clinical parameters, on behavior, or other effects).
The quality of evidence and risk of bias of the studies included in this review were classified by one reviewer (EG). The quality of evidence of primary studies was assessed following the Grading of Recommendations Assessment, Development and Evaluation guidelines [
A total of 1383 publications were identified, and after removing duplicates, 676 titles and abstracts were screened. The full search strategy and its results are summarized in
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart of the selection procedure.
Only 1 of the 35 included studies was considered to be of high quality [
The PRISMA checklist of this study can be found in
Of the 20 included studies, 19 reported clinical outcomes and only 1 study did not refer to any clinical effect [
The main reported clinical outcome was glycated hemoglobin (HbA1c). Eighteen publications evaluated HbA1c values and reported heterogeneous effects. On one hand, 4 publications reported significant improvements in HbA1c values, favoring the groups that used social media comparison with control groups. This effect has been reported in 2 systematic reviews summarizing the evidence from studies focusing on both type one diabetes (T1D) and type two diabetes (T2D) and in 2 RCTs focusing specifically on T1D [
Effects on blood pressure were reported only by 2 systematic reviews, both finding improvements associated with social media use. One of the systematic reviews referred to 5 studies with a total of 2580 patients (1317 in the intervention groups and 1263 in the control groups), where there was a significant mean difference in systolic blood pressure (3.47 mmHg, 95% CI 5.01 to 1.94,
Additional evidence on clinical effects has been reported for triglycerides and severe hypoglycemia episodes. Only 1 systematic review referred to the effect on triglycerides. This review reported the effect drawing on 10 studies with a total of 989 patients. A significant reduction of 11.05% (95% CI: 20.92 to 1.18,
Of the 20 included studies, 16 referred to different effects on behavior.
Five publications had comparable findings related to patients’ high satisfaction with the interventions where social media were used or to internet visits being preferred by patients [
Five studies reported on this item, reaching different conclusions. Two studies, an RCT and a systematic review, reported improvements in health-related quality of life (HRQoL) among T1D and T2D patients linked to social media use [
This effect was reported in 4 studies and with mixed conclusions. One study involving adolescents with T1D found significantly increased diabetes knowledge on treatment or testing in the intervention group at 4, 8, and 12 months [
Two publications reported on treatment adherence. No differences were found regarding adherence in a systematic review [
There were mixed results on this outcome as well. A systematic review described reductions in dietary fat intake, but the same review also found no effects on physical activity [
Additional reported effects on behavior were an increase in diabetes communication (
Most (14/20) of the publications focused only on young people affected with T1D, with different age groups ranging from 0 to 23 years (as specified in the studies) [
The main use of social media was as a supporting tool for the main intervention (14/20), primarily used for reinforcing regular visits and with the purpose of engaging patients in treatment and improving self-management and diabetes control. In these cases, the chosen social media channels were Facebook (group), Facebook (chat), Skype, specific social networking sites, or social media in general [
Summary of the evidence on reported outcomes (n=20).
Outcomes | Supported by number of publications | ||||
Significant positive effects | Mixed results | No significant differences | Outcome not reported | ||
HbA1cb | 13a [ |
1 [ |
4 [ |
2 [ |
|
Blood pressure | 2 [ |
0 | 0 | 18 [ |
|
Triglycerides | 1 [ |
0 | 0 | 19 [ |
|
Severe hypoglycemia | 0 | 0 | 1 [ |
19 [ |
|
HRQoLc | 2 [ |
0 | 3 [ |
15 [ |
|
Knowledge or empowerment | 2 [ |
0 | 2 [ |
16 [ |
|
Medication adherence | 1 [ |
0 | 1 [ |
18 [ |
|
Healthier self-reported life-styles | 1 [ |
1 [ |
0 | 18 [ |
|
Self-efficacy | 1 [ |
1 [ |
0 | 18 [ |
|
Depressive symptoms | 1 [ |
0 | 0 | 19 [ |
|
Perceived quality of care | 0 | 0 | 1 [ |
19 [ |
a13 studies reported improvements in HbA1c values in all study participants; 4 of these studies reported improvements only in the intervention groups (comparison with control groups) [
bHbA1c: Glycated hemoglobin.
cHRQoL: health-related quality of life.
Three RCTs studied social media as the main channel for delivering the intervention. These 3 studies used peers in educational and behavioral interventions aimed at young people affected with T1D. The purpose of these interventions was to increase diabetes knowledge and to improve clinical outcomes. These 3 studies used Facebook closed groups and Viber [
A rapid review method was used to quickly capture the current evidence on the use of social media in interventions on diabetes. Following a search in 4 databases, only 20 publications considered of adequate quality were included in this review: 3 systematic reviews and 17 primary studies.
The research evidence shows that the most commonly reported outcome in intervention studies using social media is HbA1c, followed by satisfaction with the intervention, HRQoL, and diabetes knowledge or empowerment. Most of the intervention studies using social media that evaluated HbA1c values reported significant improvements (13/16 publications) [
The 5 studies that measured satisfaction with the interventions where social media were used unanimously reported positive effects [
Health authorities have recommended educating diabetic patients and their families with the aim of improving self-management, promoting a positive behavior change, and reducing the risk of complications [
It is interesting to note that more than half of the studies used social media as a tool or resource to enhance the main intervention, and in these cases, the interventions resulted in improvements in HbA1c values. Participants in these studies who were allocated to receive education either through Facebook chat or Skype as reinforcement of the main intervention had significant decreases in HbA1c values [
These findings suggest that using social media as a supporting tool for the main intervention is beneficial for improving health outcomes in T1D patients. Furthermore, it seems that the clinical improvement is most likely to happen when the chosen social media is one of the most popular networking sites.
Our review has mainly identified studies conducted with young T1D populations; however, our conclusions are comparable to those reported in a meta-analysis published in 2014 that predominantly analyzed studies involving T2D patients [
Most of the included studies focused only on young people affected with T1D, probably because it is believed that these media are typically used by young people. Certainly, since the origin of social media, younger people have been the most frequent users of these channels. However, the presence of older generations on social media has increased in recent years, and about 80% of North Americans and Norwegians in their 40s report being social media users [
In this review, we identified many abstracts presented at conferences, but there were fewer full papers reporting methods and results in detail. Knowing further details of the method used and the interventions could help identify the mechanisms or behavior techniques that work better for improving patient outcomes. So far, it seems that studies that use social media as supporting tool and where the social media is used for delivering health education report better outcomes. However, there are not enough studies where social media was used as the main channel for delivering the intervention. In future research, one should consider using different social media channels as main sources for delivering the intervention.
In research projects, it is more common to use restricted-access social media (ie, Facebook closed groups, Facebook chat, Skype, etc), which allows the researcher to have a better control of the environment and the contents and also protect the patients’ privacy. However, the use of open social media channels offers the possibility of a large-scale impact. Providing high-quality contents on diabetes through the most commonly used open social media channels and interacting with the social media users could potentially help people with diabetes. By having access to free-of-charge quality information, they could improve their knowledge, an important prerequisite for improving self-management and health behaviors. Further research should explore how to best use open social media channels for health promotion interventions in diabetes.
Our results and conclusions might be susceptible to bias as a consequence of streamlining the systematic review process. There might be a selection bias (failure to search in additional potentially relevant databases, only 1 reviewer selecting the studies) and a publication bias (we only searched in 4 databases; we did not search for gray literature; and our search was limited to the English language). Eight of the included studies conducted in Macedonia could be based on the same study, although we treated the reported results independently, as they provided different sample sizes, different age ranges of the included participants, and different intervention periods. Because many of the included publications were abstracts presented at conferences and because we did not have access to complete data, a quantitative synthesis was not possible.
There is little evidence on the use of social media in interventions aimed at people affected with diabetes. However, after weighing the existing evidence, it seems that the use of these channels is predominantly linked to beneficial patient outcomes. Public health institutions, clinicians, and other stakeholders who aim at improving diabetes patient education should consider the use of social media in their interventions.
Search strategy (search date: February 13, 2018).
List of all potentially relevant studies that were read in full-text form but excluded from the review.
Risk of bias assessment of the systematic reviews included in the review according to the MeaSurement Tool to Assess systematic Reviews (AMSTAR) criteria (n=3).
List of excluded studies because of low Grading of Recommendations Assessment, Development and Evaluation (GRADE) scores.
Summary of publications included in the review (n=20).
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist [
glycated hemoglobin
health-related quality of life
randomized controlled trial
type 1 diabetes
type 2 diabetes
This work was supported by the Northern Norway Regional Health Authority (Helse Nord RHF), grant number HNF1370-17.
EG designed the study, performed the searches, extracted the data, assessed the quality of the studies, analyzed the data, drafted and revised the manuscript, and approved the final manuscript. RW performed searches, assessed the quality of some papers, drafted and revised the manuscript, and approved the final manuscript. EÅ helped refining the search process and in deciding inclusion or exclusion, drafted and revised the manuscript, and approved the final manuscript.
None declared.