Abstract
BackgroundDiabetes mellitus (DM) is one of the world’s greatest health threats with rising prevalence. Global digitalization leads to new digital approaches in diabetes management, such as telemedical interventions. Telemedicine, which is the use of information and communication technologies, may provide medical services over spatial distances to improve clinical patient outcomes by increasing access to diabetes care and medical information.ObjectiveThis study aims to examine whether telemedical interventions effectively improve diabetes control using studies that pooled patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), and whether the benefits are greater in patients diagnosed with T2DM than in those diagnosed with T1DM. We analyzed the primary outcome glycated hemoglobin A1c (HbA1c) and the secondary outcomes fasting blood glucose (FBG), blood pressure (BP), body weight, BMI, quality of life (QoL), cost, and time saving.MethodsPublications were systematically identified by searching Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, Embase, and CINAHL databases for studies published between January 2008 and April 2020, considering systematic reviews (SRs), meta-analyses (MAs), randomized controlled trials (RCTs), and clinical trials (CTs). Study quality was assessed using the A Measurement Tool to Assess Systematic Reviews, Effective Public Health Practice Project, and National Institute for Health and Care Excellence qualitative checklist. We organized the trials by communication technologies in real-time video or audio interventions, asynchronous interventions, and combined interventions (synchronous and asynchronous communication).ResultsFrom 1116 unique citations, we identified 31 eligible studies (n=15 high, n=14 moderate, n=1 weak, and n=1 critically low quality). We selected 21 SRs and MAs, 8 RCTs, 1 non-RCT, and 1 qualitative study. Of the 10 trials, 3 were categorized as real-time video, 1 as real-time video and audio, 4 as asynchronous, and 2 as combined intervention. Significant decline in HbA1c levels based on pooled T1DM and T2DM patients data ranged from −0.22% weighted mean difference (WMD; 95% CI −0.28 to −0.15; P<.001) to −0.64% mean difference (95% CI −1.01 to −0.26; P<.001). The intervention effect on lowering HbA1c values might be significantly smaller for patients with T1DM than for patients with T2DM. Evidence on the impact on BP, body weight, FBG, cost effectiveness, and time saving was smaller compared with HbA1c but indicated potential in some publications.ConclusionsTelemedical interventions might be clinically effective in improving diabetes control overall, and they might significantly improve HbA1c concentrations. Patients with T2DM could benefit more than patients with T1DM regarding lowering HbA1c levels. Further studies with longer duration and larger cohorts are necessary.
Highlights
BackgroundDiabetes mellitus (DM) is one of the world's greatest health threats [1]
On the basis of this, the following studies were excluded: poster, comments, letters, study protocols, proceedings papers, studies that did not specify the types of diabetes of the population, studies providing pooled data with patients diagnosed with gestational diabetes mellitus (GDM), studies providing description of technologies only; studies conducted on smartphone/mobile apps, pooled data with other technologies, duplicates, and papers focusing on prevention or diagnosis
Tchero et al [5] and Su et al [18] reported obviously smaller effects for type 1 diabetes mellitus (T1DM) patients on hemoglobin A1c (HbA1c) values than for type 2 diabetes mellitus (T2DM) patients. This systematic meta-review demonstrated that telemedical interventions might be clinically effective in the management of populations consisting of T1DM and T2DM patients
Summary
BackgroundDiabetes mellitus (DM) is one of the world's greatest health threats [1]. The global prevalence of DM will increase from around 463 million (2019) to approximately 700 million in 2045, that is, by 51% [2]. Telemedicine, which is the use of information and communication technologies, may provide medical services over spatial distances to improve clinical patient outcomes by increasing access to diabetes care and medical information. Objective: This study aims to examine whether telemedical interventions effectively improve diabetes control using studies that pooled patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), and whether the benefits are greater in patients diagnosed with T2DM than in those diagnosed with T1DM. The intervention effect on lowering HbA1c values might be significantly smaller for patients with T1DM than for patients with T2DM. Evidence on the impact on BP, body weight, FBG, cost effectiveness, and time saving was smaller compared with HbA1c but indicated potential in some publications. Conclusions: Telemedical interventions might be clinically effective in improving diabetes control overall, and they might significantly improve HbA1c concentrations. Further studies with longer duration and larger cohorts are necessary
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