SMART CARE FOR DIABETES: INTEGRATING TECHNOLOGY AND LIFESTYLE FOR BETTER OUTCOMES
Abstract
Diabetes mellitus remains a global health challenge, with increasing prevalence and significant complications, particularly in type 2 diabetes (T2D). Lifestyle factors such as diet, physical activity, and stress are critical in both the prevention and management of the disease. Simultaneously, medical technologies are transforming diabetes care by enabling more precise glycemic control.
This review synthesizes findings from 26 studies published between 2010 and 2025, selected via structured searches of PubMed, Scopus, and Web of Science. Four independent reviewers screened the titles. The review was conducted in accordance with PRISMA 2020 guidelines.
Evidence supports that dietary approaches (like low-carbohydrate, Mediterranean, and personalized nutrition) are effective in improving glycemic outcomes. Structured aerobic and resistance exercise programs are associated with significant reductions in HbA1c and improved insulin sensitivity. Stress management techniques, such as mindfulness-based interventions, offer additional psychological and metabolic benefits. CGM and insulin pump therapies, especially in hybrid closed-loop systems, significantly improve glycemic metrics and patient-reported outcomes. AI applications show promise in insulin titration and risk prediction, though integration into clinical practice requires further research.
In conclusion, integrating lifestyle modifications with medical technologies offers the greatest potential for optimizing diabetes care. Future efforts should focus on personalized approaches and equitable access to advanced therapies.
References
Ajala, O., English, P., & Pinkney, J. (2013). Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr, 97(3), 505-516. https://doi.org/10.3945/ajcn.112.042457
Aune, D., Norat, T., Leitzmann, M., Tonstad, S., & Vatten, L. J. (2015). Physical activity and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis. Eur J Epidemiol, 30(7), 529-542. https://doi.org/10.1007/s10654-015-0056-z
Boushey, C., Ard, J., Bazzano, L., Heymsfield, S., Mayer-Davis, E., Sabaté, J., Snetselaar, L., Van Horn, L., Schneeman, B., English, L. K., Bates, M., Callahan, E., Butera, G., Terry, N., & Obbagy, J. (2020). USDA Nutrition Evidence Systematic Reviews. In Dietary Patterns and Risk of Type 2 Diabetes: A Systematic Review. USDA Nutrition Evidence Systematic Review. https://doi.org/10.52570/nesr.Dgac2020.Sr0103
Chatziravdeli, V., Lambrou, G. I., Samartzi, A., Kotsalas, N., Vlachou, E., Komninos, J., & Tsartsalis, A. N. (2023). A Systematic Review and Meta-Analysis of Continuous Subcutaneous Insulin Infusion vs. Multiple Daily Injections in Type-2 Diabetes. Medicina (Kaunas), 59(1). https://doi.org/10.3390/medicina59010141
Galaviz, K. I., Narayan, K. M. V., Lobelo, F., & Weber, M. B. (2018). Lifestyle and the Prevention of Type 2 Diabetes: A Status Report. Am J Lifestyle Med, 12(1), 4-20. https://doi.org/10.1177/1559827615619159
Grace, A., Chan, E., Giallauria, F., Graham, P. L., & Smart, N. A. (2017). Clinical outcomes and glycaemic responses to different aerobic exercise training intensities in type II diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol, 16(1), 37. https://doi.org/10.1186/s12933-017-0518-6
Group, T. R. S. (2017). Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE). Bmj, 356, j1285. https://doi.org/10.1136/bmj.j1285
Guan, Z., Li, H., Liu, R., Cai, C., Liu, Y., Li, J., Wang, X., Huang, S., Wu, L., Liu, D., Yu, S., Wang, Z., Shu, J., Hou, X., Yang, X., Jia, W., & Sheng, B. (2023). Artificial intelligence in diabetes management: Advancements, opportunities, and challenges. Cell Rep Med, 4(10), 101213. https://doi.org/10.1016/j.xcrm.2023.101213
Hackett, R. A., & Steptoe, A. (2017). Type 2 diabetes mellitus and psychological stress - a modifiable risk factor. Nat Rev Endocrinol, 13(9), 547-560. https://doi.org/10.1038/nrendo.2017.64
Jing, T., Zhang, S., Bai, M., Chen, Z., Gao, S., Li, S., & Zhang, J. (2023). Effect of Dietary Approaches on Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review with Network Meta-Analysis of Randomized Trials. Nutrients, 15(14). https://doi.org/10.3390/nu15143156
Kanaley, J. A., Colberg, S. R., Corcoran, M. H., Malin, S. K., Rodriguez, N. R., Crespo, C. J., Kirwan, J. P., & Zierath, J. R. (2022). Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine. Med Sci Sports Exerc, 54(2), 353-368. https://doi.org/10.1249/mss.0000000000002800
Karamanou, M., Protogerou, A., Tsoucalas, G., Androutsos, G., & Poulakou-Rebelakou, E. (2016). Milestones in the history of diabetes mellitus: The main contributors. World J Diabetes, 7(1), 1-7. https://doi.org/10.4239/wjd.v7.i1.1
Karges, B., Schwandt, A., Heidtmann, B., Kordonouri, O., Binder, E., Schierloh, U., Boettcher, C., Kapellen, T., Rosenbauer, J., & Holl, R. W. (2017). Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes. Jama, 318(14), 1358-1366. https://doi.org/10.1001/jama.2017.13994
Kwon, S. Y., & Moon, J. S. (2025). Advances in Continuous Glucose Monitoring: Clinical Applications. Endocrinol Metab (Seoul), 40(2), 161-173. https://doi.org/10.3803/EnM.2025.2370
Maiorino, M. I., Signoriello, S., Maio, A., Chiodini, P., Bellastella, G., Scappaticcio, L., Longo, M., Giugliano, D., & Esposito, K. (2020). Effects of Continuous Glucose Monitoring on Metrics of Glycemic Control in Diabetes: A Systematic Review With Meta-analysis of Randomized Controlled Trials. Diabetes Care, 43(5), 1146-1156. https://doi.org/10.2337/dc19-1459
Mirmira, R. G., Kulkarni, R. N., Xu, P., Drossos, T., Varady, K., Knutson, K. L., Reutrakul, S., Martyn-Nemeth, P., Sargis, R. M., Wallia, A., Tuchman, A. M., Weissberg-Benchell, J., Danielson, K. K., Oakes, S. A., Thomas, C. C., Layden, B. T., May, S. C., Burbea Hoffmann, M., Gatta, E.,…Philipson, L. H. (2023). Stress and human health in diabetes: A report from the 19(th) Chicago Biomedical Consortium symposium. J Clin Transl Sci, 7(1), e263. https://doi.org/10.1017/cts.2023.646
Mudaliar, S. (2023). The Evolution of Diabetes Treatment Through the Ages: From Starvation Diets to Insulin, Incretins, SGLT2-Inhibitors and Beyond. Journal of the Indian Institute of Science, 103(1), 123-133. https://doi.org/10.1007/s41745-023-00357-w
Ni, Y. X., Ma, L., & Li, J. P. (2021). Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: A systematic review and meta-analysis. J Diabetes Investig, 12(6), 1092-1103. https://doi.org/10.1111/jdi.13439
Nimri, R., Battelino, T., Laffel, L. M., Slover, R. H., Schatz, D., Weinzimer, S. A., Dovc, K., Danne, T., & Phillip, M. (2020). Insulin dose optimization using an automated artificial intelligence-based decision support system in youths with type 1 diabetes. Nat Med, 26(9), 1380-1384. https://doi.org/10.1038/s41591-020-1045-7
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S.,…Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj, 372, n71. https://doi.org/10.1136/bmj.n71
Ribeiro, A., Carvalho, J. P. R., & Bento-Torres, N. V. O. (2023). Physical exercise as treatment for adults with type 2 diabetes: a rapid review. Front Endocrinol (Lausanne), 14, 1233906. https://doi.org/10.3389/fendo.2023.1233906
Saudek, C. D., Duckworth, W. C., Giobbie-Hurder, A., Henderson, W. G., Henry, R. R., Kelley, D. E., Edelman, S. V., Zieve, F. J., Adler, R. A., Anderson, J. W., Anderson, R. J., Hamilton, B. P., Donner, T. W., Kirkman, M. S., & Morgan, N. A. (1996). Implantable insulin pump vs multiple-dose insulin for non-insulin-dependent diabetes mellitus: a randomized clinical trial. Department of Veterans Affairs Implantable Insulin Pump Study Group. Jama, 276(16), 1322-1327.
Selam, J.-L. (2010). Evolution of Diabetes Insulin Delivery Devices. Journal of Diabetes Science and Technology, 4(3), 505-513. https://doi.org/10.1177/193229681000400302
Steineck, I., Cederholm, J., Eliasson, B., Rawshani, A., Eeg-Olofsson, K., Svensson, A.-M., Zethelius, B., Avdic, T., Landin-Olsson, M., Jendle, J., & Gudbjörnsdóttir, S. (2015). Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18 168 people with type 1 diabetes: observational study. BMJ : British Medical Journal, 350, h3234. https://doi.org/10.1136/bmj.h3234
White, J. R., Jr. (2014). A Brief History of the Development of Diabetes Medications. Diabetes Spectrum, 27(2), 82-86. https://doi.org/10.2337/diaspect.27.2.82
Yeh, Y. K., Yen, F. S., & Hwu, C. M. (2023). Diet and exercise are a fundamental part of comprehensive care for type 2 diabetes. J Diabetes Investig, 14(8), 936-939. https://doi.org/10.1111/jdi.14043
Zeinalian, R., Ahmadikhatir, S., Esfahani, E. N., Namazi, N., & Larijani, B. (2022). The roles of personalized nutrition in obesity and diabetes management: a review. J Diabetes Metab Disord, 21(1), 1119-1127. https://doi.org/10.1007/s40200-022-01016-0
Views:
13
Downloads:
15
Copyright (c) 2025 Aleksandra Maciejczyk, Katarzyna Krupa, Weronika Głowacz, Janusz Świeczkowski-Feiz
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
