Affiliation:
1. Division of Informatics, Imaging & Data Sciences, Faculty of Biology, Medicine and Health Manchester Academic Health Science Centre, School of Health Sciences University of Manchester Manchester UK
2. Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, National Institute for Health and Care Research (NIHR) School for Primary Care Research University of Manchester Manchester UK
3. Division of Population Health, Health Services Research and Primary Care, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre University of Manchester Manchester UK
4. Division of Psychology and Mental Health The University of Manchester Manchester Academic Health Science Centre Manchester UK
Abstract
AbstractAimsTelemedicine has been promoted as an effective way of managing type‐2 diabetes (T2DM) in primary care. However, the effectiveness of telemedicine is unclear. We investigated the clinical and cost‐effectiveness of different telemedicine interventions for people with T2DM, compared to usual care.MethodsWe searched Medline, Embase, Cochrane, CINHAL, ProQuest and EconLit for randomized controlled trials (RCTs) that examined the effectiveness of telemedicine interventions on clinical outcomes (HbA1c, body mass index [BMI], weight, diastolic blood pressure [DBP], systolic blood pressure [SBP], fasting blood glucose, high‐density lipoprotein [HDL] cholesterol, low‐density lipoprotein [LDL] cholesterol, total cholesterol and triglyceride) in adults with T2DM, published in English from inception until 31 December 2022. Meta‐analyses were conducted using random‐effects models pooling mean differences, heterogeneity was quantified using the I2 statistic. Publication bias was assessed using funnel plots, Egger tests and trim and fill. Subgroup analyses included type of telemedicine intervention, telemedicine mode of delivery and type of healthcare professionals. This study was registered with PROSPERO, CRD 42022375128.ResultsOf the 4093 records identified, 21 RCTs, 10,732 participants from seven regions, were included. Reported interventions included telephone (k = 16 studies), internet‐based (k = 2), videoconference (k = 2) and telephone and emails (k = 1). We observed no statistically significant differences between synchronous or asynchronous telemedicine interventions compared to usual care for HbA1c (−0.08% (−0.88 mmol/mol); 95% CI: −0.18, 0.02), BMI (0.51 kg/m2; 95% CI: −0.21, 1.22), SBP (−1.48 mmHg; 95% CI: −3.22, 0.26), DBP (3.23 mmHg; 95% CI: −0.89, 7.34), HDL‐cholesterol (0.01 mmol/L; 95% CI: −0.03, 0.05), LDL‐cholesterol (0.08 mmol/L; 95% CI: −0.22, 0.37), triglycerides (−0.08 mmol/L, 95% CI: −0.31, −0.15), total cholesterol (−0.10 mmol/L; 95% CI: −0.25, 0.04) and weight (−0.50 kg; 95% CI: −1.21, 0.21).ConclusionsTelemedicine was as effective as usual care in improving health outcomes of people with T2DM. They can provide a safe solution in times of rising demands for primary healthcare services, or in extreme events, like a global pandemic. More high‐quality RCTs are needed on the cost evaluation of telemedicine.