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
ARTICLE HIGHLIGHTS
Research 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.

Research motivation

There are numerous randomised control trials that evaluate the effectiveness of telemedicine in patients with diabetes. However, no studies have provided an in-depth analysis of the effectiveness of telemedicine for glycaemic control and other health outcomes for type 2 diabetes patients.

Research objectives

This study aimed to utilise a meta-analysis approach to synthesise results from high quality randomised controlled trials, and to comprehensively review literature on the effects of telemedicine interventions on health outcomes for patients with type 2 diabetes. The secondary aim was to analyse the effect of telemedicine characteristics, patient characteristics, and self-care outcomes on glycaemic control.

Research methods

Fourty-three relevant studies were yielded from PubMed Central, Cochrane Library, Embase and Scopus databases which satisfied quality assessment via the PEDro scale. Mean difference and standard deviation was extracted from pre- and post-intervention data regarding all outcomes of interest, and information for subgroup categories was collected. The random effects model was used to estimate outcomes and I2 was used for heterogeneity testing.

Research results

Telemedicine improves hemoglobin A1c (HbA1c), diastolic blood pressure, post-prandial glucose, fasting plasma glucose, weight, body mass index, mental quality of life and physical quality of life score significantly more than control/non-telemedicine interventions.

Subgroup analysis revealed that telemedicine interventions that involved primarily telemonitoring, used a clinical treatment model, delivered via modes such as videoconferencing and interactive telephone, at a rate less frequent than weekly, provided for a duration of 6 mo, led by allied health workers, focussed on biomedical outcomes, had high engagement level and moderate drop out rate were the most effective at reducing HbA1c.

Subgroup analysis about patient characteristics showed that Hispanic patents may benefit more than others in HbA1c reduction. Self-care subgroup analysis demonstrated that telemedicine interventions that significantly improved self-glucose monitoring and self-efficacy more than the control were found to have a higher reduction in HbA1c.

Research conclusions

Telemedicine is a useful and effective intervention for type 2 diabetes patients, which improves glycemic control and numerous other health outcomes significantly better than non-telemedicine interventions/controls. Subgroup analysis demonstrated that optimising the characteristics of telemedicine interventions may have a greater effect at improving health outcomes.

Research perspectives

In a world where telemedicine is more widely used than ever, it is important to ensure that these services are delivered at a high standard and benefit the participating patients. This study emphasises that telemedicine should be utilised as an effective approach to type 2 diabetes intervention.