Comparative effectiveness of telemedicine strategies on type 2 diabetes management: A systematic review and network meta-analysis

Abstract

The effects of telemedicine strategies on the management of diabetes is not clear. This study aimed to investigate the impact of different telemedicine strategies on glycaemic control management of type 2 diabetes patients. A search was performed in 6 databases from inception until September 2016 for randomized controlled studies that examined the use of telemedicine in adults with type 2 diabetes. Studies were independently extracted and classified according to the following telemedicine strategies: teleeducation, telemonitoring, telecase-management, telementoring and teleconsultation. Traditional and network meta-analysis were performed to estimate the relative treatment effects. A total of 107 studies involving 20,501 participants were included. Over a median of 6 months follow-up, telemedicine reduced haemoglobin A1c (HbA1c) by a mean of 0.43% (95% CI: −0.64% to −0.21%). Network meta-analysis showed that all telemedicine strategies were effective in reducing HbA1c significantly compared to usual care except for telecase-management and telementoring, with mean difference ranging from 0.37% and 0.71%. Ranking indicated that teleconsultation was the most effective telemedicine strategy, followed by telecase-management plus telemonitoring, and finally teleeducation plus telecase-management. The review indicates that most telemedicine strategies can be useful, either as an adjunct or to replace usual care, leading to clinically meaningful reduction in HbA1c.

Efficacy of Pharmacist Based Diabetes Educational Interventions on Clinical Outcomes of Adults With Type 2 Diabetes Mellitus: A Network Meta-Analysis

“…Among the 118 included studies, Chrvala et al (2016) found that HbA1c levels were reduced with an average of −0.74%, which is comparable to our NMA findings of A1c levels [−0.73%; 95%CI −1.036, −0.414], when diabetes education was provided by health care team, which involved pharmacist as a team member. This was similarly noted in another study in which a healthcare team approach, which was delivered remotely could reduce HbA1c levels by 0.58% (Lee et al, 2017). …”

Developing a strategic understanding of telehealth service adoption for COPD care management: A causal loop analysis of healthcare professionals

“…Physicians use it, albeit rarely, in combination with telemetric information for clinical decision making. The decision making process is not based on any single value, such as may be the case in diabetes [60] as COPD patients are multi-morbid, elderly, with a particular social profile [57,61]. Comparing the three CLDs, some variables are present in all of them, while some are unique for a particular HCP.…”

The Effect of Telehealth Interventions in Management of Liver Diseases: Systematic Review

“…Telesağlık uygulamalarının kan glukoz seviyesinin düzenlenmesini sağlayarak, hemoglobin A1c düzeyinin azalmasına katkıda bulunduğu belirtilmektedir. 40,41 Kronik hastalığı olan bireylere bakım verenlere yönelik hazırlanmış telesağlık uygulamalarının hasta, bakım verici ve sağlık profesyoneli arasındaki iletişimi artırarak, bakım vericilerin memnuniyetini ve konforunu, hasta ve bakım vericilere yönelik sosyal desteği artırdığı belirtilmektedir. 42,43 Videokonferansla verilen eğitimin hepatit C olan bireylerde tedavi maliyetini azalttığı, sağkalım süresi ve yaşam kalitesini artırdığı, hastalığa yönelik bilgi düzeyini artırdığı görülmektedir.…”