Efficacy of telemedicine on glycaemic control in patients with type 2 diabetes: A meta-analysis

• Published in: World journal of diabetes 2021-02, Vol.12 (2), p.170-197
• Main Authors: De Groot, Julia, Wu, Dongjun, Flynn, Declan, Robertson, Dylan, Grant, Gary, Sun, Jing
• Format: Article
• Language: English
• Subjects: Meta-Analysis
• ISSN: 1948-9358; 1948-9358
• DOI: 10.4239/wjd.v12.i2.170

Telemedicine is defined as the delivery of health services remote communication and technology. It is a convenient and cost-effective method of intervention, which has shown to be successful in improving glyceamic control for type 2 diabetes patients. The utility of a successful diabetes intervention is vital to reduce disease complications, hospital admissions and associated economic costs. To evaluate the effects of telemedicine interventions on hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), post-prandial glucose (PPG), fasting plasma glucose (FPG), weight, cholesterol, mental and physical quality of life (QoL) in patients with type 2 diabetes. The secondary aim of this study is to determine the effect of the following subgroups on HbA1c post-telemedicine intervention; telemedicine characteristics, patient characteristics and self-care outcomes. PubMed Central, Cochrane Library, Embase and Scopus databases were searched from inception until 18 of June 2020. The quality of the 43 included studies were assessed using the PEDro scale, and the random effects model was used to estimate outcomes and for heterogeneity testing. The mean difference and standard deviation data were extracted for analysis. We found a significant reduction in HbA1c [-0.486%; 95% confidence interval (CI) -0.561 to -0.410, < 0.001], DBP (-0.875 mmHg; 95%CI -1.429 to -0.321, < 0.01), PPG (-1.458 mmol/L; 95%CI -2.648 to -0.268, < 0.01), FPG (-0.577 mmol/L; 95%CI -0.710 to -0.443, < 0.001), weight (-0.243 kg; 95%CI -0.442 to -0.045, < 0.05), BMI (-0.304; 95%CI -0.563 to -0.045, < 0.05), mental QoL (2.210; 95%CI 0.053 to 4.367, < 0.05) and physical QoL (-1.312; 95%CI 0.545 to 2.080, < 0.001) for patients following telemedicine interventions in comparison to control groups. The results of the meta-analysis did not show any significant reductions in SBP and cholesterol in the telemedicine interventions compared to the control groups. The telemedicine characteristic subgroup analysis revealed that clinical treatment models of intervention, as well as those involving telemonitoring, and those provided modes of videoconference or interactive telephone had the greatest effect on HbA1c reduction. In addition, interventions delivered at a less than weekly frequency, as well as those given for a duration of 6 mo, and those lead by allied health resulted in better HbA1c outcomes. Furthermore, interventions with a focus on biomedical par