Effect of telemedicine intervention on hypoglycaemia in diabetes patients: A systematic review and meta-analysis of randomised controlled trials

Abstract

Introduction Hypoglycaemia is a clinical syndrome from various causes, which happens when the blood glucose concentration is too low. Many studies show that telemedicine intervention can improve glycemic control and has a positive impact on the management of diabetic patients. The purpose of this study was to evaluate the effect of telemedicine intervention on hypoglycemic event occurrences and results on hemoglobin A1c (HbA1c) and body mass index (BMI). Methods We searched the Cochrane Library, PubMed, Web of Science, the EBSCO host, and OVID to identify relevant studies published from January 2006 to December 2017. The work of searching, selecting and assessing risk of bias was administrated by two independent reviewers. The primary outcomes were hypoglycemic event rate and HbA1c; the secondary outcome was BMI. Results From 1246 articles, we identified 14 eligible RCTs ( n = 1324). Compared to usual care, telemedicine was found to reduce the odds of hypoglycaemia (odds ratio ( OR) = 0.42; 95% confidence interval ( CI) = 0.29–0.59; I2 = 32%; p < 0.00001). We found that the clinical relevance declined in HbA1c level compared to control group (mean difference = −0.28; 95% CI = −0.45 to −0.12; I2 = 53%; p = 0.0005), but that telemedicine had no effect on BMI (mean difference = −0.27; 95% CI = −0.86–0.31; I2 = 40%; p = 0.35). Discussion Compared to usual care, the use of telemedicine was found to improve HbA1c and reduce the risk of moderate hypoglycaemia in diabetic patients, but without significant difference in BMI.