Step counter use in type 2 diabetes: a meta-analysis of randomized controlled trials

Background: While step counter use has become popular among type 2 diabetes (T2D) patients, its effectiveness in increasing physical activity (PA) and improving glycemic control has been poorly defined. The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the association of step counter use with PA and glycemic control in T2D patients. Methods: Articles were identified by searches of PubMed, Web of Science and Cochrane Library from January 1994 to June 2013. RCTs in the English language were included, if they had assessed the effectiveness of step counters as motivating and monitoring tools in T2D patients, with reported changes in steps per day (steps/d) or glycosylated hemoglobin A1c (HbA1c), or both. Data were independently collected by 2 authors and overall estimates were made by a random-effects model. Results: Of the 551 articles retrieved, 11 RCTs were included. Step counter use significantly increased PA by 1,822 steps/d (7 studies, 861 participants; 95% confidence interval (Cl): 751 to 2,894 steps/d) in patients with T2D. Step counter use with a PA goal showed a bigger increase in PA (weighted mean difference (WMD) 3,200 steps/d, 95% Cl: 2,053 to 4,347 steps/d) than without (WMD 598 steps/d, 95% Cl: -65 to 1,260 steps/d). Further subgroup analysis suggested step counter use with a self-set PA goal (WMD 2,816 steps/d, 95% Cl: 1,288 to 4,344 steps/d) made no difference in increasing PA from a 10,000 steps/d goal (WMD 3,820 steps/d, 95% Cl: 2,702 to 4,938 steps/d). However, no significant HbA1c change was observed by step counter use (10 studies, 1,423 participants; WMD 0.02%, 95% Cl: -0.08% to 0.13%), either with (WMD 0.04%, 95% Cl: -0.21% to 0.30%) or without a PA goal (WMD 0.01%, 95% Cl: -0.10% to 0.13%). Conclusions: Step counter use is associated with a significant increase in PA in patients with T2D. However, evidence regarding its effect in improving glycemic control remains insufficient.