Published online Feb 15, 2021. doi: 10.4239/wjd.v12.i2.170
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
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.
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.
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.
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.
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.
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.
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.