Telemedicine application in the care of diabetes patients: systematic review and meta-analysis

Milena Soriano Marcolino, Junia Xavier Maia, Maria Beatriz Moreira Alkmim, Eric Boersma, Antonio Luiz Ribeiro, Milena Soriano Marcolino, Junia Xavier Maia, Maria Beatriz Moreira Alkmim, Eric Boersma, Antonio Luiz Ribeiro

Abstract

Background: The impact of telemedicine application on the management of diabetes patients is unclear, as the results are not consistent among different studies. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of telemedicine interventions on change in hemoglobin A1c (HbA1c), blood pressure, LDL cholesterol (LDL-c) and body mass index (BMI) in diabetes patients.

Methods: Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched to identify relevant studies published until April 2012, supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Of the 6.258 articles retrieved, 13 RCTs (4207 patients) were included. Random effects model was applied to estimate the pooled results.

Results: Telemedicine was associated with a statistically significant and clinically relevant absolute decline in HbA1c level compared to control (mean difference -0.44% [-4.8 mmol/mol] and 95% confidence interval [CI] -0.61 to -0.26% [-6.7 to -2.8 mmol/mol]; p<0.001). LDL-c was reduced in 6.6 mg/dL (95% CI -8.3 to -4.9; p<0.001), but the clinical relevance of this effect can be questioned. No effects of telemedicine strategies were seen on systolic (-1.6 mmHg and 95% CI -7.2 to 4.1) and diastolic blood pressure (-1.1 mmHg and 95% CI -3.0 to 0.8). The 2 studies that assessed the effect on BMI demonstrated a tendency of BMI reduction in favor of telemedicine.

Conclusions: Telemedicine strategies combined to the usual care were associated with improved glycemic control in diabetic patients. No clinical relevant impact was observed on LDL-c and blood pressure, and there was a tendency of BMI reduction in diabetes patients who used telemedicine, but these outcomes should be further explored in future trials.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow of information through the…
Figure 1. Flow of information through the different phases of the systematic review.
Figure 2. Absolute changes in HbA1c of…
Figure 2. Absolute changes in HbA1c of individual studies of telemedicine associated to usual care vs. usual care.
Figure 3. Absolute changes in LDL cholesterol…
Figure 3. Absolute changes in LDL cholesterol (A), in systolic blood pressure (B) and diastolic blood pressure (C) of individual studies of telemedicine associated to usual care vs. usual care.
Figure 4. Observed studies are shown as…
Figure 4. Observed studies are shown as open circles, and the observed point estimate is shown as open diamond.
The imputed study is shown as a filled circle, and the imputed point estimate is shown as a filled diamond.

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