Health Coaching and Its Impact in the Remote Management of Patients With Type 2 Diabetes Mellitus: Scoping Review of the Literature.

Abstract

Background: Health coaching refers to the practice of health education and promotion to drive goal-directed behavioral changes and improve an individual's well-being. Remote patient monitoring systems, which employ health coaching interventions, have been gaining interest and may aid in the management of patients with type 2 diabetes mellitus (T2DM).

Objective: This scoping review aims to summarize the impact of health coaching in the remote monitoring of patients with T2DM.

Methods: A scoping review was performed in MEDLINE, Embase, CINAHL, PsychInfo, and Web of Science up to September 2024 and was reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The initial abstract screening, full-text review, and data extraction were performed by 2 independent reviewers. Studies that evaluated the impact of health coaching on the remote management of patients with T2DM were included. Outcomes evaluated were grouped into clinical, humanistic, psychiatric, behavioral, knowledge, and economic domains. A narrative review was performed for the impact of health coaching on the remote management of patients with T2DM.

Results: Among 168,888 citations identified, 104 studies were included. Majority of the studies were conducted in North America (56/104, 53.8%) and Asia (30/104, 28.8%). Approximately half of the studies (48/104, 46.2%) were conducted in primary health care settings, and one-third of the studies (37/104, 35.6%) employed nurses as health coaches. Phone consultations were the most common modality of remote monitoring (45/104, 43.3%). The follow-up duration of most studies (64/104, 61.5%) was less than 1 year. Regarding clinical outcomes, majority of the studies (68/92, 73%) showed improvements in diabetes-related parameters, but there was no improvement in blood pressure (21/32, 66%) or hyperlipidemia control (19/32, 59%). For humanistic outcomes, health coaching was associated with higher satisfaction with diabetes-related care (10/11, 91%), but there was no improvement in quality of life (12/20, 60%). Regarding psychiatric outcomes, there was no association with improvement in depressive (8/14, 57%) or anxiety symptoms (4/5, 80%). For behavioral outcomes, most studies (12/19, 63%) showed improvement in diabetes-related self-efficacy. For knowledge outcomes, evidence was mixed, with half of the studies (5/9, 56%) showing improvement in diabetes-related knowledge. For economic outcomes, majority of the studies (8/11, 73%) did not show a reduction in health care use.

Conclusions: Health coaching was associated with improved diabetes control and self-management among patients with T2DM on remote monitoring. Its role appears limited in improving health care use, lipid parameters, and quality of life; however, this may have been confounded by the short duration of follow-up in the studies. More studies are required to identify the optimal modality and duration of digital health coaching for patients with T2DM.