JMIR Publications

ABSTRACT

Background:

Telemedicine is said to improve chronic care management and self-management in patients with chronic diseases. However, currently available guidelines for the care of patients with diabetes, hypertension or dyslipidaemia do not include evidence-based guidance on which components of telemedicine are most effective for which patient populations.

Objective:

Our primary objective was to identify, synthesise and critically appraise evidence on the effectiveness of telemedicine solutions and their components in patients with diabetes, hypertension or dyslipidaemia on clinical outcomes.

Methods:

We conducted an umbrella review of high-level evidence including systematic reviews and meta-analyses of RCTs. Based on predefined eligibility criteria, extensive automated and manual searches of the databases Pubmed, Embase, and Cochrane Library were conducted. Two authors independently screened the studies, extracted data, and carried out the quality assessments. Extracted data were presented according to intervention components and patient characteristics using defined thresholds of clinical relevance. Overall certainty of outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.

Results:

Overall, 3.564 references were identified, of which 46 studies were included after applying eligibility criteria. The majority of included studies were published after 2015. Significant and clinically relevant reduction rates for HbA1c (≤ -0.5) were found in patients with diabetes. Higher reduction rates were found for recently diagnosed patients and those with higher baseline HbA1c (> 8%). Telemedicine was not found to have a significant and clinically meaningful impact on blood pressure. Only reviews or meta-analyses reporting lipid outcomes in patients with diabetes were found. GRADE assessment revealed that overall quality of the evidence was low to very low.

Conclusions:

The results of this umbrella review indicate that telemedicine has the potential to improve clinical outcomes in patients with diabetes. Although subgroup-specific effectiveness rates favouring certain intervention and population characteristics were found, the low GRADE ratings indicate that evidence can be considered as limited. Future updates of clinical care and practice guidelines should carefully assess the methodological quality of studies and assess the overall certainty of subgroup-specific outcomes before recommending telemedicine interventions for certain patient populations.