Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Feb 15, 2021; 12(2): 170-197
Published online Feb 15, 2021. doi: 10.4239/wjd.v12.i2.170
Efficacy of telemedicine on glycaemic control in patients with type 2 diabetes: A meta-analysis
Julia De Groot, Dongjun Wu, Declan Flynn, Dylan Robertson, Gary Grant, Jing Sun
Julia De Groot, Dongjun Wu, Declan Flynn, Dylan Robertson, School of Medicine, Griffith University, Gold Coast 4222, Queensland, Australia
Gary Grant, School of Pharmacy and Pharmacology, Griffith University, Gold Coast 4222, Queensland, Australia
Jing Sun, School of Medicine and Menzies Health Institute Queensland, Griffith University, Brisbane 4222, Queensland, Australia
Author contributions: Sun J contributed to paper conceptualisation and design; Sun J and De Groot J contributed to research design; De Groot J, Flynn D and Robertson D compiled studies and extracted data; Sun J conducted statistical and meta-analysis; Wu D completed table and figure presentation; De Groot J, Wu D, Flynn D and Sun J conducted writing of the paper; Sun J and Grant G edited and proofed the final draft of the paper.
Conflict-of-interest statement: All authors declare no conflict of interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jing Sun, PhD, Associate Professor, School of Medicine and Menzies Health Institute Queensland, Griffith University, Parkland Drive, Gold Coast, Queensland, QLD 4222, Brisbane 4222, Queensland, Australia. j.sun@griffith.edu.au
Received: October 21, 2020
Peer-review started: October 21, 2020
First decision: December 4, 2020
Revised: December 7, 2020
Accepted: December 29, 2020
Article in press: December 29, 2020
Published online: February 15, 2021
Processing time: 93 Days and 18.6 Hours
Abstract
BACKGROUND

Telemedicine is defined as the delivery of health services via 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.

AIM

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.

METHODS

PubMed Central, Cochrane Library, Embase and Scopus databases were searched from inception until 18th 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 I2 for heterogeneity testing. The mean difference and standard deviation data were extracted for analysis.

RESULTS

We found a significant reduction in HbA1c [-0.486%; 95% confidence interval (CI) -0.561 to -0.410, P < 0.001], DBP (-0.875 mmHg; 95%CI -1.429 to -0.321, P < 0.01), PPG (-1.458 mmol/L; 95%CI -2.648 to -0.268, P < 0.01), FPG (-0.577 mmol/L; 95%CI -0.710 to -0.443, P < 0.001), weight (-0.243 kg; 95%CI -0.442 to -0.045, P < 0.05), BMI (-0.304; 95%CI -0.563 to -0.045, P < 0.05), mental QoL (2.210; 95%CI 0.053 to 4.367, P < 0.05) and physical QoL (-1.312; 95%CI 0.545 to 2.080, P < 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 via 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 parameters, as well as those with an engagement level > 70% and those with a drop-out rate of 10%-19.9% showed greatest HbA1c reduction. The patient characteristics investigation reported that Hispanic patients with T2DM had a greater HbA1c reduction post telemedicine intervention. For self-care outcomes, telemedicine interventions that resulted in higher post-intervention glucose monitoring and self-efficacy were shown to have better HbA1c reduction.

CONCLUSION

The findings indicate that telemedicine is effective for improving HbA1c and thus, glycemic control in patients with type 2 diabetes. In addition, telemedicine interventions were also found to significantly improved other health outcomes as well as QoL scores. The results of the subgroup analysis emphasized that interventions in the form of telemonitoring, via a clinical treatment model and with a focus on biomedical parameters, delivered at a less than weekly frequency and 6 mo duration would have the largest effect on HbA1c reduction. This is in addition to being led by allied health, through modes such as video conference and interactive telephone, with an intervention engagement level > 70% and a drop-out rate between 10%-19.9%. Due to the high heterogeneity of included studies and limitations, further studies with a larger sample size is needed to confirm our findings.

Keywords: Telehealth; Telemedicine; Telemonitoring; Behavioural change; Self-management; Diabetes

Core Tip: The findings indicate that telemedicine is effective for improving hemoglobin A1c (HbA1c) and thus, glycemic control in patients with type 2 diabetes. In addition, telemedicine interventions were also found to significantly improve other health outcomes as well as quality of life scores. The results of the subgroup analysis emphasized that interventions in the form of telemonitoring, via a clinical treatment model and with a focus on biomedical parameters, delivered at a less than weekly frequency and 6 mo duration would have the largest effect on HbA1c reduction. This is in addition to being led by allied health, through modes such as video conference and interactive telephone, with an intervention engagement level > 70% and a drop-out rate between 10%-19.9%.