Dataset Information

Clinical Improvements by Telemedicine Interventions Managing Type 1 and Type 2 Diabetes: Systematic Meta-review.

ABSTRACT:

Background

Diabetes mellitus (DM) is one of the world's greatest health threats with rising prevalence. Global digitalization leads to new digital approaches in diabetes management, such as telemedical interventions. Telemedicine, which is the use of information and communication technologies, may provide medical services over spatial distances to improve clinical patient outcomes by increasing access to diabetes care and medical information.

Objective

This study aims to examine whether telemedical interventions effectively improve diabetes control using studies that pooled patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), and whether the benefits are greater in patients diagnosed with T2DM than in those diagnosed with T1DM. We analyzed the primary outcome glycated hemoglobin A_1c (HbA_1c) and the secondary outcomes fasting blood glucose (FBG), blood pressure (BP), body weight, BMI, quality of life (QoL), cost, and time saving.

Methods

Publications were systematically identified by searching Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, Embase, and CINAHL databases for studies published between January 2008 and April 2020, considering systematic reviews (SRs), meta-analyses (MAs), randomized controlled trials (RCTs), and clinical trials (CTs). Study quality was assessed using the A Measurement Tool to Assess Systematic Reviews, Effective Public Health Practice Project, and National Institute for Health and Care Excellence qualitative checklist. We organized the trials by communication technologies in real-time video or audio interventions, asynchronous interventions, and combined interventions (synchronous and asynchronous communication).

Results

From 1116 unique citations, we identified 31 eligible studies (n=15 high, n=14 moderate, n=1 weak, and n=1 critically low quality). We selected 21 SRs and MAs, 8 RCTs, 1 non-RCT, and 1 qualitative study. Of the 10 trials, 3 were categorized as real-time video, 1 as real-time video and audio, 4 as asynchronous, and 2 as combined intervention. Significant decline in HbA_1c levels based on pooled T1DM and T2DM patients data ranged from -0.22% weighted mean difference (WMD; 95% CI -0.28 to -0.15; P<.001) to -0.64% mean difference (95% CI -1.01 to -0.26; P<.001). The intervention effect on lowering HbA_1c values might be significantly smaller for patients with T1DM than for patients with T2DM. Evidence on the impact on BP, body weight, FBG, cost effectiveness, and time saving was smaller compared with HbA_1c but indicated potential in some publications.

Conclusions

Telemedical interventions might be clinically effective in improving diabetes control overall, and they might significantly improve HbA_1c concentrations. Patients with T2DM could benefit more than patients with T1DM regarding lowering HbA_1c levels. Further studies with longer duration and larger cohorts are necessary.

SUBMITTER: Eberle C

PROVIDER: S-EPMC7935656 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Clinical Improvements by Telemedicine Interventions Managing Type 1 and Type 2 Diabetes: Systematic Meta-review.

Eberle Claudia C Stichling Stefanie S

Journal of medical Internet research 20210219 2

<h4>Background</h4>Diabetes mellitus (DM) is one of the world's greatest health threats with rising prevalence. Global digitalization leads to new digital approaches in diabetes management, such as telemedical interventions. Telemedicine, which is the use of information and communication technologies, may provide medical services over spatial distances to improve clinical patient outcomes by increasing access to diabetes care and medical information.<h4>Objective</h4>This study aims to examine w ...[more]

PMID: 33605889

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Project description:BackgroundThe prevalence of diabetes mellitus (DM) is increasing rapidly worldwide. Simultaneously, technological advances are offering new opportunities for better management of type 1 diabetes mellitus (T1DM). Telemetry, the remote acquisition of patient data via a telecommunication system, is a promising field of application in eHealth and is rapidly gaining importance.ObjectiveThe aim of this study was to summarize the current evidences available on the effectiveness of telemetric approaches in T1DM management. This systematic meta-review examined different types of interventions of the technologies used in communication between health care professionals and patients as well as the key outcomes.MethodsWe performed a systematic search in Web of Science Core Collection, EMBASE, Cochrane Library, MEDLINE via PubMed, and CINAHL databases in April 2020 with regard to the effectiveness of telemetric interventions for T1DM. We classified the interventions into 4 categories according to the technology used: (1) real-time video communication, (2) real-time audio communication, (3) asynchronous communication, and (4) combined forms of communication (real-time and asynchronous). We considered various study designs such as systematic reviews, clinical trials, meta-analyses, and randomized controlled trials and focused on the key outcomes. Additionally, a funnel plot based on hemoglobin A1c (HbA1c) values and different quality assessments were performed.ResultsWe identified 17 (6 high quality and 9 moderate quality) eligible publications: randomized controlled trials (n=9), systematic reviews and meta-analyses (n=5), cohort studies (n=2), and qualitative publications (n=1). Of 12 studies, 8 (67%) indicated a (significant or nonsignificant) reduction in HbA1c levels; 65% (11/17) of the studies reported overall (mildly) positive effects of telemetric interventions by addressing all the measured outcomes. Asynchronous interventions were the most successful for patients diagnosed with T1DM, but no technology was clearly superior. However, there were many nonsignificant results and not sustained effects, and in some studies, the control group benefited from telemetric support or increased frequency of contacts.ConclusionsBased on the currently available literature, this systematic meta-review shows that telemetric interventions cause significant reduction in HbA1c levels and result in overall positive effects in T1DM management. However, more specified effects of telemetric approaches in T1DM management should be analyzed in detail in larger cohorts.

Project description:ObjectiveTo determine the effectiveness of digital telemedicine interventions designed to improve outcomes in patients with multimorbidity.DesignSystematic review and meta-analysis of available literature.Data sourcesMEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the Database of Abstracts of Reviews of Effectiveness and hand searching. The search included articles from inception to 19 April 2019 without language restrictions. The search was updated on 7 June 2020 without additional findings.Eligibility criteriaProspective interventional studies reporting multimorbid participants employing interventions with at least one digital telemedicine component were included. Primary outcomes were patient physical or mental health outcomes, health-related quality of life scores and the utilisation of health services.ResultsOut of 5865 studies initially identified, 7 articles, reporting on 6 studies were retained (total of 699 participants). Four of these studies reported interventions including integration with usual care, two studies had interventions with no links to usual patient care. Follow-up periods lasted between 2 and 6 months. Among the studies with links to usual care, the primary outcomes were systolic blood pressure (SBP) (three studies), haemoglobin A1c (HbA1c) (three studies), total cholesterol (two studies) and self-perceived health status (one study). The evidence ranged from very low to moderate certainty. Meta-analysis showed a moderate decrease in SBP (8 mm Hg (95% CI 4.6 to 11.4)), a small to moderate decrease in HbA1c (0.46 mg/dL (95% CI 0.25 to 0.67)) and moderate decrease in total cholesterol (cholesterol 16.5 mg/dL (95% CI 8.1 to 25.0)) in the intervention groups. There was an absence of evidence for self-perceived health status. Among the studies with no links to usual care, time to hospitalisation (median time to hospitalisation 113.4 days intervention and 104.7 days control group, absolute difference 12.7 days) and the Minnesota Living with Heart Failure Questionnaire (intervention group 35.2 score points, control group 23.9 points, absolute difference 11.3, 95% CI 5.5 to 17.1) showed small reductions. The Personal Health Questionnaire (PHQ-8) showed no evidence of improvement (intervention 7.6 points, control 8.6 points, difference 1.0 points, 95% CI -22.9% to 11.9%).ConclusionDigital telemedicine interventions provided moderate evidence of improvements in measures of disease control but little evidence and no demonstrated benefits on health status. Further research is needed with clear descriptions of conditions, interventions and outcomes based on patients' and healthcare providers' preferences.Prospero registration numberCRD42019134872.

Project description:BackgroundChronic migraine can be a profoundly disabling disorder that may be treated with preventive medications. However, uncertainty remains as to which preventive medication is the most effective. We present a network meta-analysis to determine the effectiveness and rank of preventive drugs for chronic migraine in adults.MethodsWe identified, reviewed, and extracted data from randomised controlled trials (RCTs) of preventive drugs for chronic migraine with at least 200 participants. Data were analysed using network meta-analysis.FindingsWe included 12 RCTs of six medications (Eptinezumab, Erenumab, Fremanezumab, Galcanezumab, Onabotulinumtoxin A, and Topiramate) compared to placebo or each other. All drugs effectively reduced monthly headache and migraine days compared with placebo. The most effective drug for monthly headache days was Eptinezumab 300mg, with a mean difference of -2.46 days, 95% Credible Interval (CrI): -3.23 to -1.69. On the Surface Under the Cumulative Ranking Area (SUCRA) analysis, the probability that Eptinezumab 300mg was ranked highest was 0.82. For monthly migraine days, the most effective medication was Fremanezumab-monthly, with a mean difference: -2.77 days, 95% CrI: -3.36 to -2.17, and 0.98 probability of being ranked the highest. All included drugs, except Topiramate, improved headache-related quality of life. No eligible studies were identified for the other common preventive oral medications such as Amitriptyline, Candesartan, and Propranolol. The main reasons were that the studies did not define chronic migraine, were undertaken before the definition of chronic migraine, or were too small.InterpretationAll six medications were more effective than the placebo on monthly headache and migraine days. The absolute differences in the number of headache/migraine days are, at best, modest. No evidence was found to determine the relative effectiveness of the six included drugs with other oral preventive medications.RegistrationPROSPERO (number CRD42021265990).

Project description:Patient activation interventions (PAIs) engage patients in care by promoting increased knowledge, confidence, and/or skills for disease self-management. However, little is known about the impact of these interventions on a wide range of outcomes for adults with type 2 diabetes (DM2), or which of these interventions, if any, have the greatest impact on glycemic control.Electronic databases were searched from inception through November 2011. Of 16,290 citations, two independent reviewers identified 138 randomized trials comparing PAIs to usual care/control groups in adults with DM2 that reported intermediate or long-term outcomes or harms. For meta-analyses of continuous outcomes, we used a random-effects model to derive pooled weighted mean differences (WMD). For all-cause mortality, we calculated the pooled odds ratio (OR) using Peto's method. We assessed statistical heterogeneity using the I (2) statistic and conducted meta-regression using a random-effects model when I (2)?>?50 %. A priori meta-regression primary variables included: intervention strategies, intervention leader, baseline outcome value, quality, and study duration.PAIs modestly reduced intermediate outcomes [A1c: WMD 0.37 %, CI 0.28-0.45 %, I (2) 83 %; SBP: WMD 2.2 mmHg, CI 1.0-3.5 mmHg, I (2) 72 %; body weight: WMD 2.3 lbs, CI 1.3-3.2 lbs, I (2) 64 %; and LDL-c: WMD 4.2 mg/dL, CI 1.5-6.9 mg/dL, I (2) 64 %]. The evidence was moderate for A1c, low/very low for other intermediate outcomes, low for long-term mortality and very low for complications. Interventions had no effect on hypoglycemia (evidence: low) or short-term mortality (evidence: moderate). Higher baseline A1c, pharmacist-led interventions, and longer follow-up were associated with larger A1c improvements. No intervention strategy outperformed any other in adjusted meta-regression.PAIs modestly improve A1c in adults with DM2 without increasing short-term mortality. These results support integration of these interventions into primary care for adults with uncontrolled glycemia, and provide evidence to insurers who do not yet cover these programs.

Project description:BackgroundDiabetes in pregnancy is a global problem. Technological innovations present exciting opportunities for novel approaches to improve clinical care delivery for gestational and other forms of diabetes in pregnancy.ObjectiveTo perform an updated and comprehensive systematic review and meta-analysis of the literature to determine whether telemedicine solutions offer any advantages compared with the standard care for women with diabetes in pregnancy.MethodsThe review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Randomized controlled trials (RCT) in women with diabetes in pregnancy that compared telemedicine blood glucose monitoring with the standard care were identified. Searches were performed in SCOPUS and PubMed, limited to English language publications between January 2000 and January 2016. Trials that met the eligibility criteria were scored for risk of bias using the Cochrane Collaborations Risk of Bias Tool. A meta-analysis was performed using Review Manager software version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration).ResultsA total of 7 trials were identified. Meta-analysis demonstrated a modest but statistically significant improvement in HbA1c associated with the use of a telemedicine technology. The mean HbA1c of women using telemedicine was 5.33% (SD 0.70) compared with 5.45% (SD 0.58) in the standard care group, representing a mean difference of -0.12% (95% CI -0.23% to -0.02%). When this comparison was limited to women with gestational diabetes mellitus (GDM) only, the mean HbA1c of women using telemedicine was 5.22% (SD 0.70) compared with 5.37% (SD 0.61) in the standard care group, mean difference -0.14% (95% CI -0.25% to -0.04%). There were no differences in other maternal and neonatal outcomes reported.ConclusionsThere is currently insufficient evidence that telemedicine technology is superior to standard care for women with diabetes in pregnancy; however, there was no evidence of harm. No trials were identified that assessed patient satisfaction or cost of care delivery, and it may be in these areas where these technologies may be found most valuable.

Dataset Information

Clinical Improvements by Telemedicine Interventions Managing Type 1 and Type 2 Diabetes: Systematic Meta-review.

Background

Objective

Methods

Results

Conclusions

Publications

Clinical Improvements by Telemedicine Interventions Managing Type 1 and Type 2 Diabetes: Systematic Meta-review.

Similar Datasets

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