Efficacy of telemedicine on glycaemic control in patients with type 2 diabetes: A meta-analysis

Table 1 The characteristics of included studies (require insert reference for each study)

Ref.	Number centres, funding	Participants I/C	Design, location (country/territory)	Mean age intervention (SD)/mean age control (SD) (yr)	Sex (M/F)	Intervention type	Control	Measured outcomes	Key results	PEDro	Notes
Alanzi et al[36] 2018	4, none stated	10/10	NB, Saudi Arabia	8 × (18-40), 2 × (41-50)/9 × (18-40), 1 × (41-50)	15/5	Mobile application; Bluetooth transmission of blood glucose, social networking, cognitive behavioral therapy (6 mo)	Usual care	HbA1c	Greater decrease in HbA1c for intervention vs control	5	-
Arora et al[37] 2014	1, Agile Health LLC and McKesson foundation	64/64	NB, United States	50.5 (10.3)/51 (10.2)	46/82	Twice daily text messages about self-care and medication adherence (6 mo)	Usual care	HbA1c	No significant differences	4	Data converted from median (range)a
Bujnowska-Fedak et al[38] 2011	Multi-centre, none stated	50/50	NB, Poland	53.1 (25.2)/57.5 (27.4)	51/44	Transmission of blood glucose to computer network via glucometer, systems sends text to GP (6 mo)	Usual care with glucometer	HbA1c, FPG, PPG, BMI, SBP, DBP, TC	No significant differences	5	-
Cho et al[39] 2017	3, Korean Government	244/240	NB, South Korea	52.9 (9.2)/53.4 (8.7)	307/177	Glucometer and blood pressure measurements sent via internet connected device, doctors and nurses send back recommendations (6 mo)	Usual care	HbA1c, FPG, weight, BMI, SBP, DBP, TC, HDL, LDL, TG, WC, PPG, QoL	Greater decrease in HbA1c, PPG and WC for intervention vs control	6	-
Crowley et al[40] 2016	1, Veterans Affairs	25/25	NB, United States	60 (8.4)/60 (9.2)	48/2	Glucose testing sent via telephone voice system daily + fortnightly self-management modules via telephone (6 mo)	Usual care	HbA1c, SBP, DBP, Depression	Greater decrease in HbA1c, SBP, DBP for intervention vs control	6	-
Dafoulas et al[41] 2015	Multicentre, European Community	74/80	SB, Greece	58.28 (0.93)/64.11 (0.6)	68/86	Transmission of blood glucose weekly via mobile app + calls from doctors as required (12 mo)	Usual care	HbA1c, QoL	Greater decrease in HbA1c, QoL physical, QoL mental and physical activity for intervention vs control	5	-
Dario et al[42] 2017	3, European Commission and RENEWING HEALTH project	208/91	NB, Italy	73.05 (5.79)/73.04 (5.28)	168/131	Transmission of glucometer via online gateway to doctor	Usual care	HbA1c, QoL, depression, anxiety	No significant differences	5	-
Fortmann et al[43] 2017	4, Mckesson foundation and National center for advancing translational sciences grant	63/63	NB, United States	47.8 (9.0)/49.1 (10.6)	32/94	Text messages, up to 3 per day; motivational, educational or call-to-action (6 mo)	Usual care	HbA1c, FPG, TC, HDL, LDL, TG, SBP, DBP, BMI, weight	Greater decrease in HbA1c for intervention vs control	6	-
Fountoulakis et al[44] 2015	2, None stated	54/26	NB, Greece	61.3 (11.4)/63.5 (13.8)	55/25	USB-connected modem compatible with glucometer, data transmitted to computers of Department of Endocrinology	Usual care	HbA1c, BMI	Greater decrease in HbA1c for intervention vs control	5	Separates T1D and T2D data. Recruitment ‘n’ not provided
Holmen et al[45] 2014	2, European Union + 6 others	(1) 51/50, (2) 50/50	NB, Norway	58.6 (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 care	HbA1c, weight	No significant differences	5	3 arm (2 interventions)
Jeong et al[46] 2018	4, Ministry of Health and Welfare, Republic of Korea and Ministry of Trade, Industry, and Energy South Korea	(1) 113/113, (2)112/113	NB, South Korea	53.65 (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 care	HbA1c, FPG, PPG, BMI, body weight, SBP, DBP, HDL, LDL, TG	Greater decrease in FPG for (1) telemonitoring group and (2) telemedicine group vs control	6	3 arm (2 interventions)a
Kempf et al[47] 2017	Multicentre, Boehringer Ingelheim International and University Dusseldorf	102/100	SB, Germany	59 (9)/60 (8)	90/77	Glucometer, 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 counter	HbA1c, FPG, weight, BMI, SBP, DBP, TC, HDL, LDL, QoL	Greater decease in HbA1c, body weight, BMI, SBP and QoL for intervention vs control	8	TG excluded as median (IQR) and skewed
Kim et al[48] 2007	1, College of Nursing Catholic University of Korea	30/30	NB, Korea	46.8 (8.8)/47.5 (9.1)	22/29	Self-monitored glucose and medication use was submitted online and weekly recommendations were sent via text (6 mo)	Usual care	HbA1c, FPG, PPG	Greater decrease in PPG for intervention vs control	5	-
Kim et al[49] 2008	1, Korean Government	20/20	NB, Korea	45.5 (9.1)/48.5 (8)	16/18	Medications and self-monitored glucose readings were used to create online medical record + weekly recommendations sent via text message (12 mo)	Usual care	HbA1c, FPG, PPG	Greater decrease in HbA1c for intervention vs control	5	-
Kim et al[50] 2016	1, UB care	110/110	NB, China	52.5 (9.1)/55.6 (10)	88/94	Internet-based self-monitoring of blood glucose + recommendations via a website (6 mo)	Usual care	HbA1c, SBP, DBP, TC, TG, HDL, LDL	Greater decrease in HbA1c and FPG for intervention vs control	4	-
Kim et al[51] 2019	3, HealthConnect Co.	97/94	NB, South Korea	60 (8.4)/56.7 (9.1)	99/73	Smartphone modules for Bluetooth glucometer, diet, exercise via activity tracker + clinical decision support (24 wk)	Usual care + Manual glucose logbook	HbA1c, FPG, weight, SBP, DBP, TC, TG, LDL, HDL	Greater decrease in HbA1c for intervention vs control	5	a
Kleinman et al[52] 2017	3, Gather Health LLC	44/46	NB, India	48.8 (9)/48 (9.5)	63/27	Mobile app provided daily reminders for self-management tasks and data + provider communication and treatment adjustment (6 mo)	Usual care	HbA1c, FPG, BMI	Greater decrease in HbA1c, greater increase self-reported medication adherence and BG testing for intervention vs control	7
Lee et al[53] 2020	11, Ministery of Science, Technology and Innovation Malaysia	120/120	SB, Malaysia	56.1 (9.2)/56.3 (8.6)	108/132	Auto transmission of glucometer data via online portal with automatic feedback + team encouraged self-management monthly + change to medication if required (12 mo)	Usual care	HbA1c, FPG, SBP, DBP, TC, TG, HDL, LDL, QoL	Greater decrease in HbA1c for intervention vs control	7	a
Lim et al[54] 2016	1, Korea healthcare technology R&D project	50/50	NB, Korea	64.3 (5.2)/65.8 (4.7)	75/25	Bluetooth glucometer and activity monitor, and dietary and exercise transmission to website + tailored feedback to device or mobile (6 mo)	Usual care + self monitored blood glucose	HbA1c, BMI, SBP, DBP, TC, TG, LDL, HDL, WC, FPG, PPG	Greater decrease in HbA1c for intervention vs control	5	-
Liou et al[55] 2014	6, none stated	54/41	NB, Taiwan	56.6 (7.7)/57 (7.5)	48/47	6 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 nurse	HbA1c, BMI, SBP, DBP, TC, TG, LDL, HDL	Greater decrease in HbA1c for intervention vs control	5	TG excluded as log-transformeda
Luley et al[56] 2011	1, none stated	35/35	NB, Germany	59 (9)/58 (7)	34/36	Bluetooth 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 diet	Weight, BMI, HBA1c, TG, HDL, FPG	Greater decrease in HbA1c weight, BMI and FPG for intervention vs control	5	a
Nicolucci et al[57] 2015	Multi-centre, MSD Italia grant	153/149	NB, Italy	59.1(10.3)/57.8(8.9)	94/92	Bluetooth transmission weight, blood glucose and blood pressure measurements to server via internet + remote support and GP feedback	Usual care	HbA1c, weight, SBP, DBP, TC, HDL, LDL, TG, QoL	Greater decrease of HbA1c and increase of mental summary QoL for intervention vs control	4	-
Or et al[58] 2020	1, Food and Health Bureau	151/148	NB, Hong Kong	63.9 (10.2)/63.7 (9.6)	192/107	Bluetooth glucometer and BP monior + website-based technological surrogate nursing care encouraged self-management via tablet with resources (24 wk)	Usual care	HbA1c, SBP, DBP	No significant differences	7	-
Orsama et al[59] 2013	1, Finnish funding agency, Technical Research centre Finland & Bayer HealthCare	27/29	NB, Finland	62.3 (6.5)/61.5 (9.1)	26/22	Mobile app transmission of weight, blood glucose, stepcount and blood pressure + automatic feedback with behaviour change focus + website viewing of health record	Usual care	HbA1c, weight, SBP, DBP	Greater decrease in HbA1c and weight for intervention vs control	5	Baseline HbA1c up to 2 months were used
Pacaud et al[60] 2012	1, Lawson Foundation	(1) 18/21, (2) 29/21	NB, Canada	52.1 (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, QoL	No significant differences	5	5 arm (2 interventions and separation by sex). Post-test 'n 'not givena
Pressman et al[61] 2014	Multi-centre, Samsung	118/107	SB, America	54.8 (9.8)/56.4 (8.7)	122/76	Weekly transmission of blood glucose, blood pressure and weight to case manager via device + tailored telephone feedback (6 mo)	Usual care	Weight, BMI, SBP, LDL, HbA1c	No significant differences	6	a
Quinn et al[62] 2016	Multi-centre, University of Maryland and WellDoc	(1) 37/29, (2) 25/27	NB, United States	47.3 (6.8)/47.4 (7.5)	(1) 32/34, (2) 27/25	Mobile phone coaching App, entering blood glucose, diet, medication info with behavioural, motivation or feedback messages + Web portal (12 mo)	Usual care	HbA1c	Greater decease in HbA1c for intervention vs control, no statistical difference for age groups	4	3 arm (separated by age < 55 and > 55)
Ramadas et al[63] 2018	3, Monash University	66/62	NB, Malaysia	49.6 (10.7)/51.5 (10.3)	77/51	Web-based nutrition lesson plan and dietary intervention (12 mo)	Usual care	FBG, HbA1c	No significant differences	7	Mean difference provided by study for HbA1ca
Rodríguez-Idígoras et al[64] 2009	Multi-centre, Roche Diagnostics Spain	161/167	NB, Spain	63.32 (11.13)/64.52 (10.32)	169/159	Transmission of glucometer data via mobile + mobile contact by patient or healthcare staff when required + teleconsults (12 mo)	Usual care	HbA1c	Greater decrease in HbA1c for intervention vs control	7	-
Shea et al[65] 2009	2, Medicare and Medicaid + 6 more	844/821	SB, United States	70.8 (6.5)/ 70.9 (6.8)	616/1049	Home unit with web-enabled computer access to website with education + webcam for videoconferencing + auto uploading glucometer and blood pressure data (5 yr)	Usual care	HbA1c, LDL, SBP, DBP	Greater decrease in HbA1c (years 4-5) and LDL (years 1-4) and SBP (years 1-5) and DBP (years 1-5) for intervention vs control	5	Changed from Weinstock 2011, Adjusted mean used
Stone et al[66] 2010	Multi-centre, U.S. Air Force	64/73	SB, United States	3 × (< 45), 38 × (45-65), 23 × (> 65)/4 × (< 45), 43 × (45-65), 26 × (> 65)	135/2	Transmission of blood glucose, blood pressure and weight via internet-connected device + monthly phone calls: self-management education, medication changes (6 mo)	Monthly phone call	HbA1c, weight, SBP, DBP, TC, HDL, LDL, TG	Greater decrease in HbA1c for intervention vs control	7	-
Sun et al[67] 2019	1, Science Technology Department Jilin and Jilin University	44/47	NB, China	67.9 (66,71), 68.04 (66, 72) Median (IQR)	37/54	Mobile phone application + Bluetooth glucometer + advice every 2 wk via app (6 mo)	Usual care + glucometer + outpatient visits	HbA1c, PPG, FPG, TC, TG, BMI, SBP	Greater decrease in HbA1c and PPG for intervention vs control	5	HDL, LDL, BMI, DBP excluded due to median (IQR) and skewed
Tang et al[68] 2013	1, Agency for Health Research and Quality	193/189	SB, United States	54 (10.7)/53.5 (10.2)	249/166	Bluetooth glucometer readings + uploaded nutrition, exercise logs, insulin record online + messages with healthcare team and personalised text and video	Usual care	HbA1c, LDL, weight, SBP, DBP	No significant differences at 12 mo, but greater decrease in HbA1c at 6 months of intervention vs control	7	-
Vinitha et al[69] 2019	5, AstraZeneca Pharma India Ltd	126/122	NB, India	42.4 (8.5)/44.1 (8.9)	168/80	Text messages 3 times weekly: education, lifestyle, medication (24 mo)	Usual care	HbA1c, weight, BMI, WC, SBP, DBP, FPG, PPG, TC, HDL, LDL, QoL	Greater decrease in HbA1c, SBP and FPG for intervention vs control	6	TG excluded due to median (IQR) and skewed
Wang et al[70] 2017	1, Science Technology Department Jilin	106/106	NB, China	52.6 (9.1)/54.7 (10.3)	116/104	Transfer of glucometer data to health centre via website + receival of information/advice (6 mo)	Usual care	HbA1c, TC, HDL, LDL	Greater decrease in HbA1c, PPG, FPG and TG for intervention vs control	4	FPG, TG, BMI, SBP, DBP, PPG excluded due to median (IQR) and skewed
Wang et al[71] 2018	1, National Center for Clinical and Translational Sciences grant	11/6	NB, United States	58.8 (5.9)/49.2 (10.2)	7/10	Smartphone application + Bluetooth scale and glucometer + 12 in-person behaviour-change sessions (6 mo)	Usual care	HbA1c	Greater decrease in HbA1c for intervention vs control	5	Paper group intervention not included here
Wayne et al[72] 2015	2, Public Health Agency Canada	67/64	NB, Canada	53.1 (10.9)/53.3 (11.9)	28/72	Mobile phone monitoring and health coaching (6 mo)	Health coaching without mobile	HbA1c, weight, WC, BMI, depression, anxiety, QoL	Greater decrease in BMI and greater increase in QoL (Mental SF-12) for intervention vs control	5	-
Welch et al[73] 2011	1, Baystate Medical Center	25/21	NB, United States	54.4 (10.4)/57.5 (9.5)	31/15	Transmission 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 education	HbA1c, SBP, DBP, BMI	Greater decrease in HbA1c and SBP for intervention vs control	4	Depression excluded due to nil measure of variance
Whittemore et al[74] 2020	5, none stated	26/21	SB, Mexico	53.9 (9.2)/56.8 (8.3)	16/31	7 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, depression	No significant differences	7	a
Wild et al[75] 2016	4, Chief Scientist Office Grant	160/161	SB, United Kingdom	60.5 (9.8)/61.4 (9.8)	214/107	Bluetooth transmission of glucose, blood pressure and weight to website + called when lifestyle and medication changes required (9 mo)	Usual care	HbA1c, SBP, DBP, weight	Greater decrease in HbA1c, SBP and DBP for intervention vs control	7	-
Williams et al[76] 2012	3, QLD Health, HCF Health and Medical Research Foundation	60/60	NB, Australia	58.4 (8.2)/56.4 (8.3)	76/44	Bluetooth Glucometer + Interactive automated telephone system encouraging self-management behaviours (6 mo)	Usual care	HbA1c, QoL	Greater decrease in HbA1c and improved mental HRQL for intervention vs control	5	-
Xu et al[77] 2020	1, National Institutes of Health, Veterans Affairs	33/32	NB, United States	54.6 (1.82)/55.34 (1.94)	20/44	Glucose data self reported and collected by automated phone calls/texts, shared with providers with bidirectional communication (12 mo)	Usual care	HbA1c	No significant differences	5	Excluded FPG measures as it was patient-reported
Yip et al[78] 2002	1, none stated	41/41	SB, China	55.29 (8.63)/57.54 (8.52)	70/52	4 educational sessions via videoconference + telephone monitoring (4.5 mo). Outcomes measured at 6 mo)	Usual care	HbA1c	No significant differences	5	Additional non-telehealth group not included

^aP < 0.05. SBP: Systolic blood pressure; DBP: Diastolic blood pressure; BMI: Body mass index; TC: Total cholesterol; MD: Mean difference; CI: Confidence interval; FPG: Fastening plasma glucose; WC: Waist circumference; PPG: Post-prandial glucose; QoL: Quality of life.

Table 2 Result of all variable analysis of included studies in meta-analysis

Variables	Studies (n)	Participant (n)	Mean difference			Effect size			Publications Bias
			MD (95%CI)	Q test	I2 (%)	Effect size (95%CI)	Q test	I2 (%)	Egger’s t (95%CI)
HbA1c	47	6932	-0.486 (-0.561, -0.410)c	2689.381	98.290c	-1.523 (-1.896, -1.150)c	1857.351	97.523c	2.604 (-6.389, -0.815)a
SBP	22	4053	-0.458 (-1.403, 0.486)	2772.104	99.206c	-0.117 (-0.603, 0.370)	1060.208	98.019c	0.937 (-2.814, 7.432)
DBP	20	3764	-0.875 (-1.429, -0.321)b	683.275	97.219c	-0.376 (-0.743, -0.009)a	535.388	96.451c	0.896 (-5.695, 2.280)
PPG	6	1497	-1.458 (-2.648, -0.268)b	437.802	98.858c	-1.091 (-1.695, -0.486)c	256.915	98.054	0.035 (-9.234, 8.984)
FPG	15	2508	-0.577 (-0.710, -0.443)c	163.957	91.461c	-1.098 (-1.575, -0.622)c	396.579	96.470c	2.730 (-4.501, -0.524)a
Weight	17	3235	-0.243 (-0.442, -0.045)a	120.538	86.726c	-0.549 (-0.950, -0.149)b	145.580	89.009c	1.225 (-3.014, 0.814)
BMI	15	2357	-0.304 (-0.563, -0.045)a	120.110	88.344c	-0.346 (-0.514, -0.178)c	232.373	93.975c	2.963 (-4.376, -0.701)a
Cholesterol	15	2951	-0.070 (-0.141, 0.002)	492.468	97.157c	-0.339 (-0.741, 0.063)a	379.019	96.306c	1.180 (-7.845, 2.304)
Mental QoL	6	634	2.210 (0.053, 4.367)a	842.443	99.406c	0.739 (-0.709, 2.186)	736.156	99.185c	1.124 (-13.969, 32.978)
Physical QoL	7	1467	1.312 (0.545, 2.080)c	210.628	97.151c	1.111 (0.432, 1.790)c	192.042	96.876c	0.425 (-8.626, 12.046)

^aP < 0.05.

^bP < 0.01.

^cP < 0.001. SBP: Systolic blood pressure; DBP: Diastolic blood pressure; BMI: Body mass index; TC: Total cholesterol; MD: Mean difference; CI: Confidence interval; FPG: Fastening plasma glucose; PPG: Post-prandial glucose; QoL: Quality of life.

Table 3 HbA1c subgroup analysis for included studies

Subgroups	Studies (n)	Participant (n)	Mean difference			Effect size
			Q test	Mean difference (95%CI)	I2 (%)	Q test	Effect size (95%CI)	I2 (%)
Mode of intervention
Text message	5	469	55.331	-0.591 (-0.892, -0.290)c	92.771c	133.957	-1.377 (-2.503, -0.252)a	97.014c
Mobile app	12	1154	321.220	-0.359 (-0.502, -0.215)c	96.576c	281.110	-1.308 (-2.009, -0.607)c	96.087c
Interactive telephone	2	170	9.069	-0.782 (-1.172, -0.391)c	88.974b	2.226	-2.600 (-3.243, -1.957)c	55.074
Internet server/computer network	7	1288	353.994	-0.431 (-0.558, -0.304)c	98.305c	332.245	-1.751 (-2.819, -0.684)c	98.194c
Website	14	1875	843.158	-0.539 (-0.706, -0.371)c	98.458c	696.131	-1.747 (-2.587, -0.907)c	98.133c
Video conference	2	164	1.687	-0.845 (-1.144, -0.546)c	40.719	25.261	-1.450 (-3.323, 0.424)	96.041c
Device or tablet	5	1812	332.123	-0.278 (-0.747, 0.191)c	98.796c	162.677	-0.905 (-1.725, -0.085)a	97.541c
Duration of intervention, months
≤ 6	6	1158	222.519	-0.363 (-0.567, -0.159)c	97.753c	239.478	-1.290 (-2.186, -0.394)b	97.912c
6	20	2234	1260.455	-0.626 (-0.766, -0.486)c	98.493c	740.442	-2.054 (-2.712, -1.396)c	97.434c
> 6	21	2565	1173.100	-0.380 (-0.507, -0.252)c	98.295c	674.872	-1.080 (-1.583, -0.578)c	97.036c
Focus of intervention
Biomedical parameters	16	2633	1830.624	-0.687 (-0.821, -0.553)c	99.181c	844.645	-2.406 (-3.174, -1.639)c	98.224c
Self-management behaviors	7	334	64.189	-0.360 (-0.805, 0.086)	90.653c	139.861	-0.740 (-1.753, 0.274)	95.710c
Biomedical and self-management	24	3965	687.693	-0.348 (-0.442, -0.253)c	96.655c	645.659	-1.171 (-1.583, -0.759)c	96.438c
Telemedicine method
Telemonitoring	19	3076	1872.902	-0.553 (-0.662, -0.445)c	99.039c	1107.777	-2.263 (-2.991, -1.534)c	98.375c
Tele-education	12	994	125.448	-0.495 (-0.683, -0.307)c	91.231c	289.370	-1.068 (-1.767, -0.368)b	96.199c
Telemonitoring and tele-education	16	2862	501.993	-0.391 (-0.542, -0.240)c	97.012c	287.276	-1.002 (-1.415, -0.588)c	94.779c
Model of intervention
Behavior change	28	2773	629.401	-0.452 (-0.575, -0.329)c	95.710c	596.338	-1.041 (-1.426, -0.656)c	95.472c
Treatment	13	2248	1518.194	-0.589 (-0.725, -0.453)c	99.210c	710.693	-2.386 (-3.249, -1.522)c	98.312c
Behavior change and treatment	6	1911	448.804	-0.401 (-0.612, -0.189)c	98.886c	332.288	-1.934 (-3.070, -0.799)c	98.495c
Intervention lead
Doctor	11	987	522.974	-0.288 (-0.512, -0.064)a	98.088c	391.153	-0.922 (-1.795, -0.048)a	97.443c
Nurse	15	2747	868.940	-0.491 (-0.655, -0.327)c	98.389c	474.130	-1.606 (-2.205, -1.006)c	97.047c
Multi-disciplinary	17	2941	1237.843	-0.534 (-0.643, -0.425)c	98.707c	852.270	-2.038 (-2.702, -1.375)c	98.123c
Allied health	4	257	8.094	-0.939 (-1.651, -0.227)b	62.935a	11.197	-0.600 (-1.137, -0.062)a	73.208b
Dropout rate
0%-9.9%	20	2659	779.280	-0.458 (-0.584, -0.333)c	97.562c	571.285	-1.138 (-1.62, -0.657)c	96.674c
10%-19.9%	16	2795	709.022	-0.645 (-0.786, -0.504)c	97.884c	740.889	-2.329 (-3.107, -1.552)c	97.975c
20% +	10	994	365.413	-0.297 (-0.472, -0.121)c	97.537c	267.256	-0.902 (-1.632, -0.171)a	96.632c
Frequency of intervention
Daily	19	2176	996.897	-0.439 (-0.577, -0.302)c	98.194c	593.016	-1.408 (-1.959, -0.857)c	96.965c
< daily to > weekly	10	2005	627.889	-0.307 (-0.462, -0.152)c	98.567c	602.249	-1.452 (-2.300, -0.605)c	98.506c
Weekly	7	1095	448.790	-0.791 (-1.167, -0.416)c	98.663c	353.155	-2.340 (-3.576, -1.105)c	98.301c
< weekly	5	1162	30.212	-0.835 (-1.068, -0.602)c	86.760c	131.622	-2.423 (-3.943, -0.902)b	96.961c
Not mentioned	6	494	33.795	-0.227 (-0.690, 0.237)	85.205c	42.744	-0.360 (-1.010, 0.290)	88.302c
Rate of use/engagement
≤ 70%	5	808	406.483	-0.212 (-0.526, 0.102)	99.016c	254.620	-1.060 (-2.422, 0.303)	98.429c
> 70%	8	1287	150.709	-0.576 (-0.696, -0.455)c	95.355c	204.974	-2.492 (-3.514, -1.469)c	96.585c
Not mentioned	34	4837	1782.085	-0.496 (-0.589, -0.403)c	98.148c	1231.652	-1.361 (-1.771, -0.951)c	97.321c
Self-care: Medication adherence
No significant differences	4	557	57.285	-0.268 (-0.459, -0.077)b	94.763c	39.413	-0.650 (-1.254, -0.047)a	92.388c
Intervention significantly better	3	541	22.004	-0.265 (-0.677, 0.147)	90.911c	60.687	-0.783 (-1.810, 0.245)	96.704c
Not mentioned	40	5834	2414.200	-0.522 (-0.605, -0.44)c	98.385c	1538.553	-1.664 (-2.09, -1.237)c	97.465c
Self -care: Disease knowledge
No significant differences	7	685	33.269	-0.025 (-0.169, 0.118)	81.965c	39.012	-0.142 (-0.535, 0.252)	84.620c
Intervention significantly better	2	197	5.253	-0.590 (-1.401, 0.222)	80.963a	42.653	-1.220 (-3.543, 1.102)	97.655c
Not mentioned	38	6050	2399.254	-0.530 (-0.611, -0.449)c	98.458c	1584.253	-1.802 (-2.234, -1.37)c	97.655c
Self-care: Behavior change
No significant differences	3	379	0.374	-0.100 (-0.134, -0.065)c	0.000	10.944	-0.318 (-0.769, 0.132)	81.726c
Intervention significantly better	4	328	94.795	-0.532 (-1.153, 0.090)	96.835c	70.276	-1.145 (-2.347, 0.057)	95.731c
Not mentioned	40	6225	2477.596	-0.508 (-0.59, -0.427)c	98.426c	1678.368	-1.656 (-2.079, -1.234)c	97.676c
Self-care: Glucose monitoring
No significant differences	1	299	0.000	-0.100 (-0.136, -0.064)c	0.000	0.000	-0.634 (-0.866, -0.401)c	0.000
Intervention significantly better	3	434	103.754	-0.505 (-0.923, -0.087)a	98.072c	31.471	-1.795 (-2.897, -0.693)c	93.645c
Not mentioned	43	6199	2441.038	-0.498 (-0.580, -0.416)c	98.279c	1807.229	-1.527 (-1.942, -1.113)c	97.676c
Self-care: Hospital visits needed
No significant differences	2	339	29.741	-0.440 (-0.744, -0.137)b	96.638c	0.510	-2.467 (-2.750, -2.184)c	0.000
Intervention significantly better	1	246	0.000	0.010 (-0.023, 0.043)	0.000	0.000	0.082 (-0.187, 0.351)	0.000
Not mentioned	44	6347	2341.454	-0.505 (-0.586, -0.424)c	98.164c	1692.930	-1.519 (-1.906, -1.133)c	97.460c
Self-care: self-efficacy
No significant differences	6	1071	90.786	-0.232 (-0.360, -0.105)c	94.493c	71.592	-0.636 (-1.093, -0.178)b	93.016c
Intervention significantly better	1	47	0.000	-0.810 (-1.013, -0.607)c	0.000	0.000	-2.290 (-3.029, -1.552)c	0.000
Not mentioned	40	5814	2311.342	-0.514 (-0.597, -0.430)c	98.313c	1633.909	-1.638 (-2.077, -1.199)c	97.613c
Self-care: nutrition
No significant differences	4	380	42.368	-0.642 (-0.845, -0.440)c	92.919c	7.474	-2.190 (-2.608, -1.772)c	59.861
Not mentioned	43	6552	2567.224	-0.466 (-0.546, -0.387)c	98.364c	1785.184	-1.457 (-1.853, -1.061)c	97.647c
Self-care: Exercise
No significant differences	2	132	7.605	-0.641 (-0.943, -0.338)c	86.850b	0.209	-2.427 (-2.877, -1.976)c	0.000
Not mentioned	45	6800	2636.871	-0.477 (-0.554, -0.400)c	98.331c	1824.510	-1.485 (-1.866, -1.104)c	97.588c
Racial
Hispanic	2	148	2.118	-0.867 (-1.052, -0.682)c	52.782	0.502	-2.791 (-3.245, -2.337)c	0.000
Not mentioned	45	6784	2560.239	-0.464 (-0.540, -0.388)c	98.281c	1804.224	-1.471 (-1.85, -1.092)c	97.561c
Comorbid disease
Overweight/obese	4	318	50.425	-1.270 (-1.971, -0.568)c	94.051c	50.979	-2.034 (-3.280, -0.788)c	94.115c
Hypertension	1	299	0.000	-0.100 (-0.136, -0.064)c	0.000	0.000	-0.634 (-0.866, -0.401)c	0.000
Not mentioned	42	6315	2376.371	-0.439 (-0.516, -0.361)c	98.275c	1787.062	-1.499 (-1.910, -1.087)c	97.706c

Allied health, diabetes educator, dietician, councillor.

^aP < 0.05.

^bP < 0.01.

^cP < 0.001. CI: Confidence interval.