JMIR Publications

ABSTRACT

Background:

Diabetes mellitus is one of the world's greatest health threats with rising prevalence. Global digitalization leads to new digital approaches in diabetes management, such as telemetric interventions. Telemetry, the use of information and communication technologies, may improve clinical patient outcomes by increasing access to diabetes care and medical information.

Objective:

To examine whether telemetric interventions effectively improve diabetic control overall using studies that pooled type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients (1), and whether the benefits are greater in patients diagnosed with T2DM than T1DM (2), analyzing primary outcome glycated hemoglobin A1c (HbA1c) and secondary outcomes fasting blood glucose (FBG), blood pressure (BP), body weight, body mass index (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 January 2008 to April 2020 considering systematic reviews (SRs), meta-analyzes (MAs), randomized controlled and clinical trials (RCTs and CTs). Study quality was assessed using “A MeaSurement Tool to Assess systematic Reviews” (AMSTAR 2), “Effective Public Health Practice Project” (EPHPP) and “National Institute for Health and Care Excellence” (NICE) qualitative checklist. We organized the trials by communication technologies in “real time video/audio interventions”, “asynchronous interventions” and “combined interventions” (synchronous and asynchronous communication).

Results:

From 1116 unique citations, we identified n=31 eligible studies (n=15 high, n=14 moderate, n=1 weak and n=1 critically low quality). We selected n=21 SRs and MAs, n=8 RCTs, n=1 non-randomized controlled trial and n=1 qualitative study. Of n=10 trials, n=3 were categorized as “real-time video”, n=1 as “real-time video and audio”, n=4 as “asynchronous”, and n=2 as “combined” intervention. Significant decline in HbA1c 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% MD (95% CI, -1.01 to -0.26, P=.0009). The intervention effect on lowering HbA1c values was significantly smaller for T1DM than for T2DM patients. Evidence on the impact on blood pressure, body weight, fasting blood glucose, cost-effectiveness, time saving was smaller compared to HbA1c but indicated great potential in some publications.

Conclusions:

Telemetric interventions were clinically effective in improving diabetic control in studies that pooled T1DM and T2DM participants overall, and they especially improved HbA1c concentrations effectively. T2DM patients clearly benefited more than T1DM patients regarding lowering HbA1c levels. Clinical Trial: Not applicable.