Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 23, 2024
Date Accepted: Sep 4, 2025
Clinical Improvements from Telemedicine Interventions for Managing Type 2 Diabetes Compared to Usual Care: A Systematic Review, Meta-Analysis, and Meta-Regression
ABSTRACT
Background:
Background:
Type 2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disorder that poses substantial challenges to global healthcare systems and patient management. Telemedicine, defined as the use of information and communication technologies to enhance healthcare delivery, has emerged as a potential tool to improve access to care and facilitate the management of T2DM.
Objective:
Objective:
This systematic review and meta-analysis aimed to evaluate the clinical effectiveness of various telemedicine interventions compared to usual care in glycemic control, body weight, and cardiovascular health in adults with T2DM.
Methods:
Methods:
A comprehensive literature search was conducted across databases such as PubMed, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) published up to 23 August 2024. Eligible RCTs compared telemedicine interventions with usual care in adults with type 2 diabetes. The primary outcome assessed was HbA1c levels, while the secondary outcomes included mean glucose, fasting blood glucose (FBG), body mass index (BMI), weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c). Data were extracted and analyzed using a random-effects model, and meta-regression was performed to explore potential moderators.
Results:
Results:
A total of 58 RCTs, encompassing 13,942 participants, were included in the analysis. Our findings showed that telemedicine interventions significantly improved HbA1c levels compared to usual care (MD = -0.38; 95% CI = -0.49, -0.27; Z = 6.94; P < 0.01), despite high heterogeneity (I² = 96%). Subgroup analyses revealed that telemedicine delivered by physicians, dietitians, and researchers achieved the most significant reductions in HbA1c levels. Furthermore, short-term and long-term interventions showed significant HbA1c improvements, while medium-term interventions did not achieve statistical significance. Evidence for effects on FBG, mean glucose, blood pressure, and cardiovascular health management was less conclusive compared to HbA1c but showed potential in some included studies.
Conclusions:
Conclusion: This review highlights telemedicine's superior effectiveness over usual care in improving HbA1c levels in patients with T2DM, regardless of the type of intervention. Telemedicine led by physicians, dietitians, and researchers showed the greatest efficacy in managing blood glucose levels. Furthermore, telemedicine interventions show promise for monitoring weight and cardiovascular health in patients with T2DM. Clinical Trial: PROSPERO International Prospective Register of Systematic Reviews CRD42024608130.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.