Meta-analysis of Telemonitoring to Improve HbA1c Levels: Promises for Stroke Survivors

Abstract

Background: Diabetes mellitus predisposes to ischemic stroke, a major cause of death in this population, and worsens the post-stroke prognosis. Monitoring glycemic control is useful not only in the primary prevention of stroke in diabetics, but also in the rehabilitation from and secondary prevention of stroke. In an often functionally and neurocognitively impaired population, however, poor compliance to treatment regimens is a major problem. Digital, wireless telemonitoring glucometers offer a solution to the compliance issue—not only do they give patients a dynamic experience of their own glycemic control via digital monitors, but many also have an integrated alert system with healthcare providers and more real-time feedback than traditional self-monitoring methods. Objective: To evaluate effectiveness of telemonitoring technologies in improving long-term glycemic control. Methods: A search on www.clinicaltrials.gov on November 2013, using keywords “telemonitoring” (n=103), “selfcare device” (n=50), and “self management device” (n=210), revealed trials investigating a range of chronic disease including heart disease, diabetes, COPD, asthma, and hypertension. Some of the cardiac-oriented trials utilized varying outcome measurements. Therefore, we only selected published diabetes trials comparing HbA1c levels of a group receiving standard of care to a group receiving a telemonitoring intervention. Using a random effects model of mean difference, a meta-analysis was conducted on five trials that measured differences in HbA1c levels between the two groups at six months follow-up. Results: Five clinical trials were identified. Four of the five studies showed a greater reduction in HbA1c in the intervention group compared to controls at 6 months, although only one was statistically significant. There was considerable heterogeneity between studies (I2= 69.5%, p=0.02). The random effects model estimated the aggregate effect size for mean difference in reduction of HbA1c levels in the treatment group vs. control to be 0.08% [-0.12- 0.28%], which was not statistically significant (p=0.42). Conclusions: The varying results may be due to specific factors in the trials that contributed to their large heterogeneity. Although there is great potential to use telemonitoring in stroke patients, further trials are needed to support its role in improving diabetes management in this population. Nonetheless, in the future telemonitoring may substantially help patients at risk of ischemic stroke and those who require close glucose monitoring.