JMIR Publications

ABSTRACT

Background:

Importance: Telemedicine has revolutionized the management of type 2 diabetes mellitus (T2DM) in primary care by improving access to healthcare services and enhancing health outcomes. Despite these advancements, it remains unclear whether telemedicine has reduced access inequalities among different demographic and socioeconomic groups.

Objective:

Objective:

To investigate the most important demographic and socioeconomic factors associated with telemedicine use among individuals with T2DM in primary care.

Methods:

Design: Systematic review and meta-analysis. Data sources: MEDLINE, EMBASE, PsycINFO, Google Scholar, SCOPUS, and CINAHL from inception to December 2023. The reference lists of eligible studies and other relevant systematic reviews were also searched.

Methods:

We included observational and cohort studies that assessed the effects of telemedicine interventions on individuals with T2DM in primary care. The core outcome were the factors associated with telemedicine use, reported as adjusted odds ratios (AORs) with their 95% confidence intervals for each factor, using a random-effects model. Heterogeneity was quantified using the I² statistic, and publication bias was assessed. The protocol for this review was registered at PROSPERO (ID: CRD42024550410).

Results:

Results:

Of the 3000 records identified, 16 studies involving 71 336 patients were included in the meta-analysis. Female patients had higher odds of using telemedicine than male patients (pooled OR: 1.053; 95% CI: 1.02 to 1.09). Older adults were significantly less likely to use telemedicine than younger adults (pooled OR: 0.979; 95% CI: 0.98 to 0.98). Compared to White patients, Black patients were less likely to use telemedicine (pooled OR: 0.55; 95% CI: 0.32 to 0.94), while no statistically significant differences were observed for Hispanic (pooled OR: 1.075; 95% CI: 0.36 to 3.24) or Asian participants (pooled OR: 0.56; 95% CI: 0.29 to 1.06). Patients with higher education levels had greater odds of using telemedicine than those with lower education levels (pooled OR: 1.681; 95% CI: 1.48 to 1.91).

Conclusions:

Conclusion: This systematic review and meta-analysis provide evidence of significant disparities in telemedicine utilisation among men, older adults, black individuals and those with lower levels of education who have T2DM in primary care. Given that these groups are among the most vulnerable to T2DM, these disparities highlight the critical need for strategic interventions and robust policy that ensure telemedicine fosters equitable access to healthcare, while preventing further exacerbation of existing health inequalities.