Comparative effectiveness of telemonitoring versus usual care for type 2 diabetes: A systematic review and meta-analysis

Abstract

Aims This study evaluated clinical effectiveness of telemonitoring on the management of patients with type 2 diabetes. Methods We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane Library to identify randomized controlled trials that compared telemonitoring and usual care in patients with type 2 diabetes. Results Thirty-eight studies (6855 patients) were included. Telemonitoring was associated with a significant decrease in glycated haemoglobin levels compared to usual care (weighted mean difference –0.42%, 95% confidence interval –0.56 to –0.27) but there was evidence of heterogeneity ( I2 = 96.9%). Telemonitoring was associated with a significant glycated haemoglobin reduction when biological data were transmitted through a web-based device weekly, when voice feedback was performed daily or immediately and when patients were provided with counselling. Telemonitoring also reduced glycated haemoglobin level in studies that monitored patients’ medication adherence, provided counselling, education and alarm message. The rate of achieving glycated haemoglobin levels of < 7% was 1.8 times higher in the telemonitoring group compared to the usual care group (risk ratio 1.83, 95% confidence interval 1.35 to 2.47, I2 = 0%). There was also significant reduction in systolic blood pressure (weighted mean difference –1.33 mm Hg) and body mass index (weighted mean difference –0.25 kg/m2), but the clinical relevance of these results can be questioned. The data available on patient satisfaction, quality of life, medication adherence, prescription changes, stress and depression were limited. Conclusions Telemonitoring interventions may be a better option than usual care in improving glycated haemoglobin control of patients with type 2 diabetes. Further studies should assess clinical benefit according to specific delivery modes of the intervention and patient-reported outcomes.