Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis

Abstract

Objective To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. Methods We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties. Findings We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of −0.38 for glycated haemoglobin (95% confidence interval, CI: −0.52 to −0.23; I 2 = 86.70%), −0.20 for fasting blood sugar (95% CI: −0.32 to −0.08; I 2 = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I 2 = 93.75%), 0.55 for diabetes knowledge (95% CI: −0.10 to 1.20; I 2 = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I 2 = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of −0.04 for body mass index (95% CI: −0.13 to 0.05; I 2 = 35.94%), −0.06 for total cholesterol (95% CI: −0.16 to 0.04; I 2 = 59.93%) and −0.02 for triglycerides (95% CI: −0.12 to 0.09; I 2 = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications. Conclusion Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.

Cost-effectiveness of telemedicine care for patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia

“…For example, according to a systematic review and meta-analysis by Zhai and colleagues, 33 a statistically significant reduction in the HbA1c level in the telemedicine group compared with that of the control group was reported (pooled mean difference = −0.37, 95% CI = −0.49 to −0.25, p < 0.001). Moreover, a recent meta-analysis by Correia and colleagues, 36 which focused on telemedicine interventions implemented in low- and middle-income countries, indicated that telemedicine interventions were effective for diabetes management and resulted in significant reductions in HbA1c levels (standardized mean differences = −0.38, 95% CI = −0.52 to −0.23). In a study from Japan, Onishi and colleagues 39 reported that among patients with diabetes having HbA1c ⩾ 7% before the pandemic outbreak, providing diabetes care through telemedicine during the state of emergency resulted in an improvement to HbA1c < 7% after the emergency period in Japan.…”

“…[30][31][32] Before the pandemic, many studies indicated the clinical effectiveness of telemedicine in diabetes care, including significant and clinically relevant reductions in HbA1c. [31][32][33][34][35][36][37][38] Moreover, during the COVID-19 pandemic, two studies from Japan 39 and Saudi Arabia 40 reported similar positive clinical outcomes in terms of glycemic control. In addition, it has been shown that increasing patient contact through frequent phone calls improves patient therapy adherence, motivation, and metabolic control.…”

Diabetes mellitus as a risk factor for SARS-CoV-2 test positivity in Mexico: A propensity score matched study

“…Third, while awaiting immunization delivery and administration for individuals with diabetes, the care of patients with diabetes should continue to be adapted to optimize care continuity while mitigating the risk of SARS-CoV-2 exposure, such as through the use of telemedicine and mobile health platforms (37).…”

“…Second, strategies for the timely and equitable distribution and administration of COVID-19 vaccines, which have been primarily allocated to high-income countries [34] , should consider the high concurrent burden of diabetes and COVID-19 in LMICs and improve allocation efforts to reach those at highest risk living in lower resource contexts. Third, while awaiting immunization delivery and administration for individuals with diabetes, the care of patients with diabetes should continue to be adapted to optimize care continuity while mitigating the risk of SARS-CoV-2 exposure, such as through the use of telemedicine and mobile health platforms [35] .…”

Translation and Validation of the Questionnaire on Acceptance to Telemedicine from the Technology Acceptance Model (TAM) for Use in Malaysia

“…In developed countries, change in governance and relaxation of regulations from professional and regulatory agencies in conducting video consultation have been observed during this public health emergency [ 4 ]. Evaluation of telemedicine has found it to be convenient to patients [ 5 , 6 ], improve their intermediate outcome [ 7 ], and be cost-effective [ 8 ] and cost-saving [ 9 ].…”