Meta-Analysis
Copyright ©The Author(s) 2021.
World J Diabetes. Feb 15, 2021; 12(2): 170-197
Published online Feb 15, 2021. doi: 10.4239/wjd.v12.i2.170
Table 1 The characteristics of included studies (require insert reference for each study)
Ref.Number centres, fundingParticipants I/CDesign, location (country/territory)Mean age intervention (SD)/mean age control (SD) (yr)Sex (M/F)Intervention typeControlMeasured outcomesKey resultsPEDroNotes
Alanzi et al[36] 20184, none stated10/10NB, Saudi Arabia8 × (18-40), 2 × (41-50)/9 × (18-40), 1 × (41-50)15/5Mobile application; Bluetooth transmission of blood glucose, social networking, cognitive behavioral therapy (6 mo)Usual careHbA1cGreater decrease in HbA1c for intervention vs control5-
Arora et al[37] 20141, Agile Health LLC and McKesson foundation64/64NB, United States50.5 (10.3)/51 (10.2)46/82Twice daily text messages about self-care and medication adherence (6 mo)Usual careHbA1cNo significant differences4Data converted from median (range)a
Bujnowska-Fedak et al[38] 2011Multi-centre, none stated50/50NB, Poland53.1 (25.2)/57.5 (27.4)51/44Transmission of blood glucose to computer network via glucometer, systems sends text to GP (6 mo)Usual care with glucometerHbA1c, FPG, PPG, BMI, SBP, DBP, TCNo significant differences5-
Cho et al[39] 20173, Korean Government244/240NB, South Korea52.9 (9.2)/53.4 (8.7)307/177Glucometer and blood pressure measurements sent via internet connected device, doctors and nurses send back recommendations (6 mo)Usual careHbA1c, FPG, weight, BMI, SBP, DBP, TC, HDL, LDL, TG, WC, PPG, QoLGreater decrease in HbA1c, PPG and WC for intervention vs control6-
Crowley et al[40] 20161, Veterans Affairs25/25NB, United States60 (8.4)/60 (9.2)48/2Glucose testing sent via telephone voice system daily + fortnightly self-management modules via telephone (6 mo)Usual careHbA1c, SBP, DBP, DepressionGreater decrease in HbA1c, SBP, DBP for intervention vs control6-
Dafoulas et al[41] 2015Multicentre, European Community74/80SB, Greece58.28 (0.93)/64.11 (0.6)68/86Transmission of blood glucose weekly via mobile app + calls from doctors as required (12 mo)Usual careHbA1c, QoLGreater decrease in HbA1c, QoL physical, QoL mental and physical activity for intervention vs control5-
Dario et al[42] 20173, European Commission and RENEWING HEALTH project208/91NB, Italy73.05 (5.79)/73.04 (5.28)168/131Transmission of glucometer via online gateway to doctorUsual careHbA1c, QoL, depression, anxietyNo significant differences5-
Fortmann et al[43] 20174, Mckesson foundation and National center for advancing translational sciences grant63/63NB, United States47.8 (9.0)/49.1 (10.6)32/94Text messages, up to 3 per day; motivational, educational or call-to-action (6 mo)Usual careHbA1c, FPG, TC, HDL, LDL, TG, SBP, DBP, BMI, weightGreater decrease in HbA1c for intervention vs control6-
Fountoulakis et al[44] 20152, None stated54/26NB, Greece61.3 (11.4)/63.5 (13.8)55/25USB-connected modem compatible with glucometer, data transmitted to computers of Department of EndocrinologyUsual careHbA1c, BMIGreater decrease in HbA1c for intervention vs control5Separates T1D and T2D data. Recruitment ‘n’ not provided
Holmen et al[45] 20142, European Union + 6 others(1) 51/50, (2) 50/50NB, Norway58.6 (11.8)/55.9 (12.2)(1) 64/37, (2) 55/45(1) mobile phone based self-management system app (automatic blood glucose transmission, input of diet and exercise info, goal managing). (2) Intervention 1 + telephone behaviour-change counselling from nurse for first 4 mo (12 mo)Usual careHbA1c, weightNo significant differences53 arm (2 interventions)
Jeong et al[46] 20184, Ministry of Health and Welfare, Republic of Korea and Ministry of Trade, Industry, and Energy South Korea(1) 113/113, (2)112/113NB, South Korea53.65 (9.10)/53.16 (9.06)(1) 64/37, (2) 55/45(1) telemonitoring: outpatient clinic + tablet unit with auto blood glucose and weight transmission, diet and exercise monitoring with automated feedback texts. (2) telemedicine: intervention 1 + videoconference outpatient clinic (24 wk)Usual careHbA1c, FPG, PPG, BMI, body weight, SBP, DBP, HDL, LDL, TGGreater decrease in FPG for (1) telemonitoring group and (2) telemedicine group vs control63 arm (2 interventions)a
Kempf et al[47] 2017Multicentre, Boehringer Ingelheim International and University Dusseldorf102/100SB, Germany59 (9)/60 (8)90/77Glucometer, weight and pedometer data auto uploaded to online portal + weekly phone calls about lifestyle change and self-management (12 wk, 52 wk follow-up data)Usual care with self-management guide, scale and step counterHbA1c, FPG, weight, BMI, SBP, DBP, TC, HDL, LDL, QoLGreater decease in HbA1c, body weight, BMI, SBP and QoL for intervention vs control8TG excluded as median (IQR) and skewed
Kim et al[48] 20071, College of Nursing Catholic University of Korea30/30NB, Korea46.8 (8.8)/47.5 (9.1)22/29Self-monitored glucose and medication use was submitted online and weekly recommendations were sent via text (6 mo)Usual careHbA1c, FPG, PPGGreater decrease in PPG for intervention vs control5-
Kim et al[49] 20081, Korean Government20/20NB, Korea45.5 (9.1)/48.5 (8)16/18Medications and self-monitored glucose readings were used to create online medical record + weekly recommendations sent via text message (12 mo)Usual careHbA1c, FPG, PPGGreater decrease in HbA1c for intervention vs control5-
Kim et al[50] 20161, UB care110/110NB, China52.5 (9.1)/55.6 (10)88/94Internet-based self-monitoring of blood glucose + recommendations via a website (6 mo)Usual careHbA1c, SBP, DBP, TC, TG, HDL, LDLGreater decrease in HbA1c and FPG for intervention vs control4-
Kim et al[51] 20193, HealthConnect Co.97/94NB, South Korea60 (8.4)/56.7 (9.1)99/73Smartphone modules for Bluetooth glucometer, diet, exercise via activity tracker + clinical decision support (24 wk)Usual care + Manual glucose logbookHbA1c, FPG, weight, SBP, DBP, TC, TG, LDL, HDLGreater decrease in HbA1c for intervention vs control5a
Kleinman et al[52] 20173, Gather Health LLC44/46NB, India48.8 (9)/48 (9.5)63/27Mobile app provided daily reminders for self-management tasks and data + provider communication and treatment adjustment (6 mo)Usual careHbA1c, FPG, BMIGreater decrease in HbA1c, greater increase self-reported medication adherence and BG testing for intervention vs control7
Lee et al[53] 202011, Ministery of Science, Technology and Innovation Malaysia120/120SB, Malaysia56.1 (9.2)/56.3 (8.6)108/132Auto transmission of glucometer data via online portal with automatic feedback + team encouraged self-management monthly + change to medication if required (12 mo)Usual careHbA1c, FPG, SBP, DBP, TC, TG, HDL, LDL, QoLGreater decrease in HbA1c for intervention vs control7a
Lim et al[54] 20161, Korea healthcare technology R&D project50/50NB, Korea64.3 (5.2)/65.8 (4.7)75/25Bluetooth glucometer and activity monitor, and dietary and exercise transmission to website + tailored feedback to device or mobile (6 mo)Usual care + self monitored blood glucoseHbA1c, BMI, SBP, DBP, TC, TG, LDL, HDL, WC, FPG, PPGGreater decrease in HbA1c for intervention vs control5-
Liou et al[55] 20146, none stated54/41NB, Taiwan56.6 (7.7)/57 (7.5)48/476 sessions about diet, medication, stress management, goal setting and foot care, including 2 via teleconference (6 mo)Usual care + 1 in-person education session by nurseHbA1c, BMI, SBP, DBP, TC, TG, LDL, HDLGreater decrease in HbA1c for intervention vs control5TG excluded as log-transformeda
Luley et al[56] 20111, none stated35/35NB, Germany59 (9)/58 (7)34/36Bluetooth transmission from scales and accelerometer via Homebox to server + weekly feedback and progress via letters + low calorie diet (6 mo)Usual care + conventional low fat dietWeight, BMI, HBA1c, TG, HDL, FPGGreater decrease in HbA1c weight, BMI and FPG for intervention vs control5a
Nicolucci et al[57] 2015Multi-centre, MSD Italia grant153/149NB, Italy59.1(10.3)/57.8(8.9)94/92Bluetooth transmission weight, blood glucose and blood pressure measurements to server via internet + remote support and GP feedbackUsual careHbA1c, weight, SBP, DBP, TC, HDL, LDL, TG, QoLGreater decrease of HbA1c and increase of mental summary QoL for intervention vs control4-
Or et al[58] 20201, Food and Health Bureau151/148NB, Hong Kong63.9 (10.2)/63.7 (9.6)192/107Bluetooth glucometer and BP monior + website-based technological surrogate nursing care encouraged self-management via tablet with resources (24 wk)Usual careHbA1c, SBP, DBPNo significant differences7-
Orsama et al[59] 20131, Finnish funding agency, Technical Research centre Finland & Bayer HealthCare27/29NB, Finland62.3 (6.5)/61.5 (9.1)26/22Mobile app transmission of weight, blood glucose, stepcount and blood pressure + automatic feedback with behaviour change focus + website viewing of health recordUsual careHbA1c, weight, SBP, DBPGreater decrease in HbA1c and weight for intervention vs control5Baseline HbA1c up to 2 months were used
Pacaud et al[60] 20121, Lawson Foundation(1) 18/21, (2) 29/21NB, Canada52.1 (8.8)/56.3 (8.1)(1) 10/8, (2) 12/17(1) Webstatic: email consults (12 mo). 1A-male, 1B-female. (2) Web Interactive: online chat and email consults. 2A-male, 2B-female. (12 mo)Usual care + education (face-to-face education, group sessions)HbA1c, QoLNo significant differences55 arm (2 interventions and separation by sex). Post-test 'n 'not givena
Pressman et al[61] 2014Multi-centre, Samsung118/107SB, America54.8 (9.8)/56.4 (8.7)122/76Weekly transmission of blood glucose, blood pressure and weight to case manager via device + tailored telephone feedback (6 mo)Usual careWeight, BMI, SBP, LDL, HbA1cNo significant differences6a
Quinn et al[62] 2016Multi-centre, University of Maryland and WellDoc(1) 37/29, (2) 25/27NB, United States47.3 (6.8)/47.4 (7.5)(1) 32/34, (2) 27/25Mobile phone coaching App, entering blood glucose, diet, medication info with behavioural, motivation or feedback messages + Web portal (12 mo)Usual careHbA1cGreater decease in HbA1c for intervention vs control, no statistical difference for age groups43 arm (separated by age < 55 and > 55)
Ramadas et al[63] 20183, Monash University66/62NB, Malaysia49.6 (10.7)/51.5 (10.3)77/51Web-based nutrition lesson plan and dietary intervention (12 mo)Usual careFBG, HbA1cNo significant differences7Mean difference provided by study for HbA1ca
Rodríguez-Idígoras et al[64] 2009Multi-centre, Roche Diagnostics Spain161/167NB, Spain63.32 (11.13)/64.52 (10.32)169/159Transmission of glucometer data via mobile + mobile contact by patient or healthcare staff when required + teleconsults (12 mo)Usual careHbA1cGreater decrease in HbA1c for intervention vs control7-
Shea et al[65] 20092, Medicare and Medicaid + 6 more844/821SB, United States70.8 (6.5)/ 70.9 (6.8)616/1049Home unit with web-enabled computer access to website with education + webcam for videoconferencing + auto uploading glucometer and blood pressure data (5 yr)Usual careHbA1c, LDL, SBP, DBPGreater decrease in HbA1c (years 4-5) and LDL (years 1-4) and SBP (years 1-5) and DBP (years 1-5) for intervention vs control5Changed from Weinstock 2011, Adjusted mean used
Stone et al[66] 2010Multi-centre, U.S. Air Force64/73SB, United States3 × (< 45), 38 × (45-65), 23 × (> 65)/4 × (< 45), 43 × (45-65), 26 × (> 65)135/2Transmission of blood glucose, blood pressure and weight via internet-connected device + monthly phone calls: self-management education, medication changes (6 mo)Monthly phone callHbA1c, weight, SBP, DBP, TC, HDL, LDL, TGGreater decrease in HbA1c for intervention vs control7-
Sun et al[67] 20191, Science Technology Department Jilin and Jilin University44/47NB, China67.9 (66,71), 68.04 (66, 72) Median (IQR)37/54Mobile phone application + Bluetooth glucometer + advice every 2 wk via app (6 mo)Usual care + glucometer + outpatient visitsHbA1c, PPG, FPG, TC, TG, BMI, SBPGreater decrease in HbA1c and PPG for intervention vs control5HDL, LDL, BMI, DBP excluded due to median (IQR) and skewed
Tang et al[68] 20131, Agency for Health Research and Quality193/189SB, United States54 (10.7)/53.5 (10.2)249/166Bluetooth glucometer readings + uploaded nutrition, exercise logs, insulin record online + messages with healthcare team and personalised text and videoUsual careHbA1c, LDL, weight, SBP, DBPNo significant differences at 12 mo, but greater decrease in HbA1c at 6 months of intervention vs control7-
Vinitha et al[69] 20195, AstraZeneca Pharma India Ltd126/122NB, India42.4 (8.5)/44.1 (8.9)168/80Text messages 3 times weekly: education, lifestyle, medication (24 mo)Usual careHbA1c, weight, BMI, WC, SBP, DBP, FPG, PPG, TC, HDL, LDL, QoLGreater decrease in HbA1c, SBP and FPG for intervention vs control6TG excluded due to median (IQR) and skewed
Wang et al[70] 20171, Science Technology Department Jilin106/106NB, China52.6 (9.1)/54.7 (10.3)116/104Transfer of glucometer data to health centre via website + receival of information/advice (6 mo)Usual careHbA1c, TC, HDL, LDLGreater decrease in HbA1c, PPG, FPG and TG for intervention vs control4FPG, TG, BMI, SBP, DBP, PPG excluded due to median (IQR) and skewed
Wang et al[71] 20181, National Center for Clinical and Translational Sciences grant11/6NB, United States58.8 (5.9)/49.2 (10.2)7/10Smartphone application + Bluetooth scale and glucometer + 12 in-person behaviour-change sessions (6 mo)Usual careHbA1cGreater decrease in HbA1c for intervention vs control5Paper group intervention not included here
Wayne et al[72] 20152, Public Health Agency Canada67/64NB, Canada53.1 (10.9)/53.3 (11.9)28/72Mobile phone monitoring and health coaching (6 mo)Health coaching without mobileHbA1c, weight, WC, BMI, depression, anxiety, QoLGreater decrease in BMI and greater increase in QoL (Mental SF-12) for intervention vs control5-
Welch et al[73] 20111, Baystate Medical Center25/21NB, United States54.4 (10.4)/57.5 (9.5)31/15Transmission of comprehensive patient data to clinician via internet + 7 in-person visits of 1 h diabetes education (12 mo)7 in-person visits of 1 h diabetes educationHbA1c, SBP, DBP, BMIGreater decrease in HbA1c and SBP for intervention vs control4Depression excluded due to nil measure of variance
Whittemore et al[74] 20205, none stated26/21SB, Mexico53.9 (9.2)/56.8 (8.3)16/317 weekly self-management group sessions + 6 mo daily text messages about behaviour change + unconnected glucometer (6 mo)Usual care (waitlist for intervention)HbA1c, SBP, DBP BMI, depressionNo significant differences7a
Wild et al[75] 20164, Chief Scientist Office Grant160/161SB, United Kingdom60.5 (9.8)/61.4 (9.8)214/107Bluetooth transmission of glucose, blood pressure and weight to website + called when lifestyle and medication changes required (9 mo)Usual careHbA1c, SBP, DBP, weightGreater decrease in HbA1c, SBP and DBP for intervention vs control7-
Williams et al[76] 20123, QLD Health, HCF Health and Medical Research Foundation60/60NB, Australia58.4 (8.2)/56.4 (8.3)76/44Bluetooth Glucometer + Interactive automated telephone system encouraging self-management behaviours (6 mo)Usual careHbA1c, QoLGreater decrease in HbA1c and improved mental HRQL for intervention vs control5-
Xu et al[77] 20201, National Institutes of Health, Veterans Affairs33/32NB, United States54.6 (1.82)/55.34 (1.94)20/44Glucose data self reported and collected by automated phone calls/texts, shared with providers with bidirectional communication (12 mo)Usual careHbA1cNo significant differences5Excluded FPG measures as it was patient-reported
Yip et al[78] 20021, none stated41/41SB, China55.29 (8.63)/57.54 (8.52)70/524 educational sessions via videoconference + telephone monitoring (4.5 mo). Outcomes measured at 6 mo)Usual careHbA1cNo significant differences5Additional non-telehealth group not included