PMID- 33605889
OWN - NLM
STAT- MEDLINE
DCOM- 20210528
LR  - 20210528
IS  - 1438-8871 (Electronic)
IS  - 1439-4456 (Print)
IS  - 1438-8871 (Linking)
VI  - 23
IP  - 2
DP  - 2021 Feb 19
TI  - Clinical Improvements by Telemedicine Interventions Managing Type 1 and Type 2 
      Diabetes: Systematic Meta-review.
PG  - e23244
LID - 10.2196/23244 [doi]
LID - e23244
AB  - BACKGROUND: Diabetes mellitus (DM) is one of the world's greatest health threats 
      with rising prevalence. Global digitalization leads to new digital approaches in 
      diabetes management, such as telemedical interventions. Telemedicine, which is 
      the use of information and communication technologies, may provide medical 
      services over spatial distances to improve clinical patient outcomes by 
      increasing access to diabetes care and medical information. OBJECTIVE: This study 
      aims to examine whether telemedical interventions effectively improve diabetes 
      control using studies that pooled patients with type 1 diabetes mellitus (T1DM) 
      and type 2 diabetes mellitus (T2DM), and whether the benefits are greater in 
      patients diagnosed with T2DM than in those diagnosed with T1DM. We analyzed the 
      primary outcome glycated hemoglobin A(1c) (HbA(1c)) and the secondary outcomes 
      fasting blood glucose (FBG), blood pressure (BP), body weight, BMI, quality of 
      life (QoL), cost, and time saving. METHODS: Publications were systematically 
      identified by searching Cochrane Library, MEDLINE via PubMed, Web of Science Core 
      Collection, Embase, and CINAHL databases for studies published between January 
      2008 and April 2020, considering systematic reviews (SRs), meta-analyses (MAs), 
      randomized controlled trials (RCTs), and clinical trials (CTs). Study quality was 
      assessed using the A Measurement Tool to Assess Systematic Reviews, Effective 
      Public Health Practice Project, and National Institute for Health and Care 
      Excellence qualitative checklist. We organized the trials by communication 
      technologies in real-time video or audio interventions, asynchronous 
      interventions, and combined interventions (synchronous and asynchronous 
      communication). RESULTS: From 1116 unique citations, we identified 31 eligible 
      studies (n=15 high, n=14 moderate, n=1 weak, and n=1 critically low quality). We 
      selected 21 SRs and MAs, 8 RCTs, 1 non-RCT, and 1 qualitative study. Of the 10 
      trials, 3 were categorized as real-time video, 1 as real-time video and audio, 4 
      as asynchronous, and 2 as combined intervention. Significant decline in HbA(1c) 
      levels based on pooled T1DM and T2DM patients data ranged from -0.22% weighted 
      mean difference (WMD; 95% CI -0.28 to -0.15; P<.001) to -0.64% mean difference 
      (95% CI -1.01 to -0.26; P<.001). The intervention effect on lowering HbA(1c) 
      values might be significantly smaller for patients with T1DM than for patients 
      with T2DM. Evidence on the impact on BP, body weight, FBG, cost effectiveness, 
      and time saving was smaller compared with HbA(1c) but indicated potential in some 
      publications. CONCLUSIONS: Telemedical interventions might be clinically 
      effective in improving diabetes control overall, and they might significantly 
      improve HbA(1c) concentrations. Patients with T2DM could benefit more than 
      patients with T1DM regarding lowering HbA(1c) levels. Further studies with longer 
      duration and larger cohorts are necessary.
CI  - (c)Claudia Eberle, Stefanie Stichling. Originally published in the Journal of 
      Medical Internet Research (http://www.jmir.org), 19.02.2021.
FAU - Eberle, Claudia
AU  - Eberle C
AUID- ORCID: 0000-0001-7878-2020
AD  - Medicine with specialization in Internal Medicine and General Medicine, 
      Hochschule Fulda - University of Applied Sciences, Fulda, Germany.
FAU - Stichling, Stefanie
AU  - Stichling S
AUID- ORCID: 0000-0002-1017-1976
AD  - Medicine with specialization in Internal Medicine and General Medicine, 
      Hochschule Fulda - University of Applied Sciences, Fulda, Germany.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20210219
PL  - Canada
TA  - J Med Internet Res
JT  - Journal of medical Internet research
JID - 100959882
SB  - IM
MH  - Diabetes Mellitus, Type 1/*therapy
MH  - Diabetes Mellitus, Type 2/*therapy
MH  - Humans
MH  - Quality of Life
MH  - Telemedicine/*methods
PMC - PMC7935656
OTO - NOTNLM
OT  - disease management
OT  - eHealth
OT  - mobile phone
OT  - systematic review
OT  - telemedicine
OT  - type 1 diabetes
OT  - type 2 diabetes
COIS- Conflicts of Interest: None declared.
EDAT- 2021/02/20 06:00
MHDA- 2021/05/29 06:00
PMCR- 2021/02/19
CRDT- 2021/02/19 12:11
PHST- 2020/08/05 00:00 [received]
PHST- 2020/10/28 00:00 [accepted]
PHST- 2020/10/16 00:00 [revised]
PHST- 2021/02/19 12:11 [entrez]
PHST- 2021/02/20 06:00 [pubmed]
PHST- 2021/05/29 06:00 [medline]
PHST- 2021/02/19 00:00 [pmc-release]
AID - v23i2e23244 [pii]
AID - 10.2196/23244 [doi]
PST - epublish
SO  - J Med Internet Res. 2021 Feb 19;23(2):e23244. doi: 10.2196/23244.