JMIR Publications

ABSTRACT

Background:

The prevalence of Diabetes mellitus (DM) increases rapidly worldwide. At the same time technological advances offer new opportunities for a better disease management targeting type 1 diabetes mellitus (T1DM). Telemetry, the remote acquisition of patient data via a telecommunication system, is a promising field of application of Electronic Health (eHealth), and quickly growing in importance.

Objective:

We summarized the current evidence for 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 their key outcomes.

Methods:

We 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 in T1DM. We classified the interventions in four 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 (SRs), clinical trials (CT), meta-analysis (MAs), randomized controlled trials (RCTs), and focussed on key outcomes. Additionally, a funnel plot based on HbA1c values and different quality assessments were performed.

Results:

We identified n=17 eligible publications (n=6 high and n=9 moderate quality) in total: RCTs (n=9), SRs and MAs (n=5), cohort studies (n=2), and one qualitative publication (n=1). Of n=12 studies, n=8 (66.7%) indicated a (significant or not significant) reduction in HbA1c levels. 64,7% (n=11) reported overall (mildly) positive effects in terms of telemetric interventions by addressing all measured outcomes. Moreover, “asynchronous interventions” were most successful for patients diagnosed with T1DM, but no technology was clearly superior. However, there were many nonsignificant results, not sustained effects, and in some studies, the control group benefited from telemetric support or increased frequency of contacts.

Conclusions:

This systematic meta-review shows significant reduction in HbA1c levels and reports overall positive effects of telemedical interventions in T1DM based on the currently available literature. However, more specified effects of telemetric approaches in T1DM management should be analysed in detail in larger cohorts.