Distal technology interventions in people with diabetes: an umbrella review of multiple health outcomes

Abstract

Aim To summarize and evaluate the existing evidence on the effectiveness of distal technology with regard to multiple health outcomes in people with diabetes. Methods We searched PubMed, EMBASE and the Cochrane Database of Systematic Reviews from database inception to 31 August 2018 for systematic reviews and/or meta-analyses of studies that examined the impact of distal technology and reported any clinical or patient-related outcomes among people with type 1 or type 2 diabetes. Results The umbrella review identified 95 reviews, including 162 meta-analyses with 46 unique outcomes. Evidence from meta-analyses of randomized controlled studies supports the use of distal technology, especially telehealth and mHealth (healthcare delivered by mobile technology), in people with diabetes for improving HbA 1c values by 2-4 mmol/ mol (0.2-0.4%). For other health outcomes, such as changes in fasting plasma glucose levels, risk of diabetic ketoacidosis or frequency of severe hypoglycaemia, the evidence was weaker. No evidence was reported for most patient-reported outcomes including quality of life, self-efficacy and medication-taking. The evidence base was poor, with most studies rated as low to very low quality. Conclusion Distal technologies were associated with a modest improvement in glycaemic control, but it was unclear if they improved major clinical outcomes or were cost-effective in people with diabetes. More robust research to improve wider outcomes in people with diabetes is needed before such technologies can be recommended as part of routine care for any patient group.

Using telemedicine to support care for people with type 2 diabetes mellitus: a qualitative analysis of patients’ perspectives

“…SMBG is often used as an early indicator for detecting hypoglycaemia, monitoring severe hyperglycaemia and encouraging physical activity as well as improving diet control. The long-term individualised patient data are often used to inform treatment regimens 8…”

Feasibility of computer-generated telephonic message-based follow-up system among healthcare workers with diabetes: a randomized controlled trial

“…The magnitude of this reduction is similar to previous systematic reviews. [13][14][15] While we did not follow-up patients in the long-term to see changes in clinical outcomes, the enthusiasm for the messages and the intervention on whole give reason to be optimistic.…”

“…[8][9][10][11][12] Three systematic reviews have looked at the effect on diabetes. A network meta-analysis 13 and an umbrella review 14 both suggested reduction in hemoglobin A1c (HbA1c), while another also found reduction in HbA1c but no change in clinical outcomes. 15 Overall, they found the studies of low methodological quality at best.…”

“…15 Overall, they found the studies of low methodological quality at best. 14 Thus, there is a need for well-conducted randomized controlled trials (RCTS) on the use of telemedicine among healthcare workers with diabetes. In Changing Lifestyle in Diabetics (CLIDS) via short message service (SMS) trial, our hypothesis was that SMS messages might be helpful in improving diabetic control status, quality of life and sense of well-being among the healthcare workers as well.…”

Aloe vera and health outcomes: An umbrella review of systematic reviews and meta‐analyses

“…We applied the credibility assessment criteria as proposed by several previously published umbrella reviews (Belbasis et al, 2015; Chakranon et al, 2019; Dinu, Pagliai, Casini, & Sofi, 2018; Dragioti et al, 2019). We categorized reported outcomes from each meta‐analysis into convincing, highly suggestive, suggestive, weak, or non‐significant based on sample size, statistically significant of summary effect sizes using random effect model (i.e., p ≤ .05), prediction intervals excluded the null, presence of large heterogeneity ( I 2 > 50%), presence of small‐study effects and excess significance bias (Table 1).…”