An interactive virtual assistant device that provides behavioral intervention reduced mental distress while also improving quality of life, medication adherence, and glycemic control in older adults with type 2 diabetes (T2D), a randomized trial showed.

The findings came from the IVAM-ED open-label clinical trial of 112 adults aged 65 years or older, randomly assigned to either a specially programmed Smart Speaker Echo Dot third generation (Amazon’s Alexa) or usual care for 12 weeks.

The findings “suggest that this easily implemented self-management intervention could enhance health outcomes in this population,” wrote study author Lucas S. Matzenbacher, MD, of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil, and colleagues.

Moreover, they noted, “These devices are more financially accessible than other electronic ones and can provide continuous and personalized support through a user-friendly, voice-activated interface. This is particularly relevant for older adults, as they often face functional limitations and may lack the fine motor skills required to operate more complex devices.”

The results were published online on January 23, 2026, in JAMA Network Open.

Mental Distress, Other Factors Improved

The trial took place between June 22, 2023, and February 8, 2024, and 103 participants completed the 12 weeks. Those assigned to the virtual assistant intervention received the speaker for home use, installed by a member of the research team. It was programmed to deliver medication and glucose test reminders, health tips, and educational podcasts to improve both diabetes management and mental health.

The behavioral intervention was developed by a multidisciplinary diabetes care group specifically for the study. Participants were provided a user manual to explain the device’s main commands, that is, “Alexa, play music,” to encourage them to use the device for its native functions and the diabetes intervention.

The primary outcome was between-group differences in mental distress at 12 weeks on the Brazilian version of the self-reporting questionnaire-20 (SRQ-20), which assesses depression, anxiety, and other common mental health disorders, with scores ranging from 0 to 20.

At 12 weeks, the baseline-adjusted mean SRQ-20 was 6.39 vs 7.66 for the smart speaker group vs the usual care group, for a mean difference (MD) of -1.28 (P = .04). The difference remained significant after adjustment for sociodemographic variables (-1.46; P = .02), “suggesting a reduction in mental distress among participants who used the smart speaker and a positive impact of the intervention on mental health,” Matzenbacher and colleagues said.

Among the secondary outcomes, those in the intervention group had higher scores on the 36-Item Short Form Health Survey, which assessed quality of life with scores ranging from 0 to 100 in each of eight domains. Here, the fully adjusted MD was 9.46 (P = .001), indicating improved quality of life. Stress levels assessed by the Perceived Stress Scale did not differ significantly (P = .07).

The intervention was also associated with greater treatment adherence, as assessed by the Self-Care Inventory-Revised (P < .001), and with lower A1c levels (7.56% vs 8.04%; P = .01). There were no significant between-group differences in blood pressure, total cholesterol, low-density lipoprotein cholesterol, or triglycerides.

In sensitivity analyses, greater MDs were observed among female and younger participants and among those without a positive screening for cognitive decline or anxiety. No adverse events were reported.

Voice Activation Important for Older Adults

In an accompanying editorial, Nestoras Mathioudakis, MD, of the Division of Endocrinology, Diabetes & Metabolism at Johns Hopkins University School of Medicine in Baltimore, pointed out that while there have been several previous studies of digital tools for diabetes self-management and mental health support, this one is novel in using a trained smart speaker to deliver the intervention.

“A voice-activated, hands-free, home-embedded interface may be particularly well suited for older adults with visual impairment, limited dexterity, or other functional limitations that can make web-based or smartphone apps less effective,” Mathioudakis said.

“As a diabetes specialist caring for many older adults with type 2 diabetes who face challenges like those in this trial, I find these results encouraging as a potential therapeutic option,” he added.

However, he noted that several practical considerations remain, including the need for WiFi, the fact that only about 15%-25% of adults aged over 55 years own a smart speaker, and that their cost can range from about $30 to over $200. “If such interventions are deemed effective, insurance coverage or other financing mechanisms will be important to ensure access.”

Mathioudakis also said that the trial’s short duration and primary focus on mental distress “underscore the need for longer-term studies powered for glycemic control and other clinical outcomes in diverse populations.”

In the future, “voice-based agents could become a practical adjunct to diabetes care for older — and potentially younger — adults. Moving from pilot to practice will require demonstrating durable benefit, ensuring equitable access and coverage, safeguarding privacy and safety, and integrating these tools into routine care,” he concluded.

The study was supported by a grant from the Brazilian National Council for Scientific and Technological Development; Ministry of Science, Technology and Innovation; National Fund for Scientific and Technological Development. The study received financial support from the Brazilian Federal Agency for Support and Evaluation of Graduate Education. The authors and Mathioudakis reported having no further disclosures.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape Medical News, with other work appearing in the Washington Post, NPR’s Shots blog, and diaTribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social.