Do health information technology self-management interventions improve glycemic control in medically underserved adults with diabetes? A systematic review and meta-analysis.
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ABSTRACT: Objective:The purpose of this systematic review and meta-analysis was to examine the effect of health information technology (HIT) diabetes self-management education (DSME) interventions on glycemic control in medically underserved patients. Materials and Methods:Following an a priori protocol, 5 databases were searched. Studies were appraised for quality using the Cochrane Risk of Bias assessment. Studies reporting either hemoglobin A1c pre- and post-intervention or its change at 6 or 12 months were eligible for inclusion in the meta-analysis using random effects models. Results:Thirteen studies met the criteria for the systematic review and 10 for the meta-analysis and represent data from 3257 adults with diabetes (mean age 55 years; 66% female; 74% racial/ethnic minorities). Most studies ( n ?=?10) reflected an unclear risk of bias. Interventions varied by HIT type: computer software without Internet ( n ?=?2), cellular/automated telephone ( n ?=?4), Internet-based ( n ?=?4), and telemedicine/telehealth ( n ?=?3). Pooled A1c decreases were found at 6 months (-0.36 (95% CI, -0.53 and -0.19]; I 2? =?35.1%, Q ?=?5.0), with diminishing effect at 12 months (-0.27 [95% CI, -0.49 and -0.04]; I 2? =?42.4%, Q ?=?10.4). Discussion:Findings suggest that medically underserved patients with diabetes achieve glycemic benefit following HIT DSME interventions, with dissipating but significant effects at 12 months. Telemedicine/telehealth interventions were the most successful HIT type because they incorporated interaction with educators similar to in-person DSME. Conclusion:These results are similar to in-person DSME in medically underserved patients, showing that well-designed HIT DSME has the potential to increase access and improve outcomes for this vulnerable group.
SUBMITTER: Heitkemper EM
PROVIDER: S-EPMC6080842 | biostudies-literature | 2017 Sep
REPOSITORIES: biostudies-literature
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