Currently submitted to: Journal of Medical Internet Research
Date Submitted: Jun 11, 2026
Open Peer Review Period: Jun 12, 2026 - Aug 7, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The impact of telemedicine-based interventions on glycosylated hemoglobin, BMI, and self-efficacy in diabetic patients: a systematic review and meta-analysis
ABSTRACT
Background:
Diabetes affects 11.1% of adults worldwide, and care access is limited by cost and specialist shortages. Prior meta-analyses used small samples and rarely assessed publication bias or evidence certainty.
Objective:
To estimate telemedicine's effect on glycated hemoglobin (HbA1c), body mass index (BMI), and self-efficacy in diabetes, explore heterogeneity, and grade evidence certainty.
Methods:
DATA SOURCES PubMed, EMBASE, the Cochrane Library, and Web of Science from inception to May 15, 2026. STUDY SELECTION Randomized clinical trials (RCTs) of telemedicine vs usual care, in-person care, or no intervention in type 1, 2, or gestational diabetes (T1DM, T2DM, GDM) reporting HbA1c, BMI, or self-efficacy. Of 7,033 records, 145 RCTs (147 arms) were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened, extracted, and assessed risk of bias (Joanna Briggs Institute tool) per PRISMA 2020. Random-effects (REML) models included subgroup and meta-regression analyses by diabetes type, comorbidity, and duration. Publication bias used Egger's test, trim-and-fill, PET-PEESE, and worst-case meta-analysis; certainty was graded with GRADE. PROSPERO: CRD420261387371. MAIN OUTCOMES AND MEASURES Mean differences (MDs) for HbA1c and BMI; standardized mean differences (SMDs) for self-efficacy; 95% CIs.
Results:
In 31,657 participants, telemedicine reduced HbA1c (k = 133; MD, −0.36%; 95% CI, −0.43 to −0.28) and improved self-efficacy (k = 22; SMD, 0.57; 95% CI, 0.21 to 0.94) but did not affect BMI (k = 64; MD, −0.23 kg/m²; 95% CI, −0.46 to 0.01). The HbA1c effect varied by diabetes type (P for interaction < 0.001; near-null in GDM), comorbidity (P = 0.016; largest with depression or anxiety, MD, −0.68%), and duration (P = 0.030; weaker beyond 6 months); residual I² = 76.7%. All bias corrections attenuated the HbA1c estimate (PET P = 0.197); the self-efficacy estimate did not survive trim-and-fill or worst-case analysis. GRADE certainty was very low for HbA1c and self-efficacy and low for BMI.
Conclusions:
Telemedicine was associated with modest improvements in HbA1c and self-efficacy but not BMI, strongest in T2DM, comorbid depression or anxiety, and interventions ≤3 months. However, certainty was low to very low, and bias corrections suggest the pooled effects may be inflated. Targeted, short-duration telemedicine is promising but not sufficient for broad implementation; rigorous pre-registered RCTs are needed.
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