Abstract
Primary health care physicians are increasingly offering telehealth services to patients not only for its cost and time saving advantages but for the additional benefits telehealth can provide for patients with type 2 diabetes (T2D) such as improved self-management behaviours. To support the development of telehealth based T2D clinical care models in primary health care settings, a narrative synthesis and meta-analysis of randomised controlled trial studies was completed for 29 studies that evaluated the effect of one or more types of telehealth interventions on HbA1c levels compared to usual care alone. Results from the random effects meta-analysis demonstrated that telehealth interventions had a stronger influence on HbA1c compared to usual care with a mean difference in HbA1c \\% −0.18 (CI −0.35, −0.01), p = 0.04. Results from the subgroup meta-analysis demonstrated that telehealth interventions, when grouped by type of telemonitoring (mHealth and telephone communication), all have a stronger effect on lowering HbA1c levels; however, none of these findings were significant. Key findings from this review demonstrate that telehealth interventions that address T2D self-management behaviours and have higher levels of health care provider engagement, have greater effects on lowering HbA1c levels compared to usual care alone.
Highlights
The term “telehealth” is defined by the International Organisation for Standardisation as the ”use of telecommunication techniques for the purpose of providing telemedicine, medical education, and health education over a distance” [1]
Of the 17 studies that had evaluated the effectiveness of telemonitoring for type 2 diabetes management, 9 studies [4,5,8,31,33,34,35,36,37] reported statistically significant changes between the telemonitoring intervention groups and control groups measured by a reduction in mean HbA1c levels
In a similar systematic review conducted by Lee et al [47], the greatest effect on type 2 diabetes related outcomes was seen in telephone-delivered interventions, followed by Internet blood glucose monitoring system interventions, and lastly, interventions involving the automatic transmission of self-monitored blood glucose data (SMBG) using a mobile phone or a telehealth unit
Summary
The term “telehealth” is defined by the International Organisation for Standardisation as the ”use of telecommunication techniques for the purpose of providing telemedicine, medical education, and health education over a distance” [1]. The World Health Organisation defines telemedicine as “the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities” [2] Whilst these descriptions are quite similar, the term “telehealth” encompasses all forms of remote health care services whereas “telemedicine” describes the remote delivery of “clinical” services [2]. Primary care physicians are increasingly offering remote care services to their patients through video, telephone and web/mobile-based applications as they recognise the benefits that telehealth can bring such as health cost savings, greater patient compliance with treatment plans [3], improved communication between health care providers and patients [4,5,6,7] and early identification of abnormalities [8]
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