Abstract

Abstract for: Digital Health Design for Leverage: Transitioning to Proactive Health Ecosystems through Systems Thinking.

Introduction Digital health interventions for Type 2 Diabetes (T2D) frequently encounter a "sustainability plateau" where initial clinical gains are eroded by systemic friction. Current designs often prioritize low-leverage parameters, triggering archetypes like "Shifting the Burden" that limit long-term efficacy.
Approach This study utilizes Donella Meadows' leverage points framework to conduct an integrative review of 48 studies (2017--2026). We analyze the implementation gap by mapping current digital health strategies against the hierarchy of systemic leverage, with a specific focus on the emerging role of Generative AI and Value-Based Care (VBC) models.
Results The analysis reveals a critical "leverage gap": 85\% of interventions focus on low-leverage points (LP12--LP10). However, high-leverage opportunities were identified in information flows (LP6) through AI-filtered clinical signals, and in system rules (LP5) via aligned reimbursement models. We demonstrate how transitioning to these points can bridge the structural gap between technological capacity and institutional constraints.
Discussion Shifting from tool-centric monitoring to system-aware informatics repositioned digital health as a catalyst for equitable and durable clinical remission. These findings provide a conceptual roadmap for designers and policymakers to move beyond episodic care toward proactive health ecosystems.

Introduction	Digital health interventions for Type 2 Diabetes (T2D) frequently encounter a "sustainability plateau" where initial clinical gains are eroded by systemic friction. Current designs often prioritize low-leverage parameters, triggering archetypes like "Shifting the Burden" that limit long-term efficacy.
Approach	This study utilizes Donella Meadows' leverage points framework to conduct an integrative review of 48 studies (2017--2026). We analyze the implementation gap by mapping current digital health strategies against the hierarchy of systemic leverage, with a specific focus on the emerging role of Generative AI and Value-Based Care (VBC) models.
Results	The analysis reveals a critical "leverage gap": 85\% of interventions focus on low-leverage points (LP12--LP10). However, high-leverage opportunities were identified in information flows (LP6) through AI-filtered clinical signals, and in system rules (LP5) via aligned reimbursement models. We demonstrate how transitioning to these points can bridge the structural gap between technological capacity and institutional constraints.
Discussion	Shifting from tool-centric monitoring to system-aware informatics repositioned digital health as a catalyst for equitable and durable clinical remission. These findings provide a conceptual roadmap for designers and policymakers to move beyond episodic care toward proactive health ecosystems.