Telemedicine application in the care of diabetes patients: systematic review and meta-analysis
The impact of telemedicine application on the management of diabetes patients is unclear, as the results are not consistent among different studies. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of telemedi...
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| creator | Marcolino, Milena Soriano Maia, Junia Xavier Alkmim, Maria Beatriz Moreira Boersma, Eric Ribeiro, Antonio Luiz |
| description | The impact of telemedicine application on the management of diabetes patients is unclear, as the results are not consistent among different studies. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of telemedicine interventions on change in hemoglobin A1c (HbA1c), blood pressure, LDL cholesterol (LDL-c) and body mass index (BMI) in diabetes patients.
Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched to identify relevant studies published until April 2012, supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Of the 6.258 articles retrieved, 13 RCTs (4207 patients) were included. Random effects model was applied to estimate the pooled results.
Telemedicine was associated with a statistically significant and clinically relevant absolute decline in HbA1c level compared to control (mean difference -0.44% [-4.8 mmol/mol] and 95% confidence interval [CI] -0.61 to -0.26% [-6.7 to -2.8 mmol/mol]; p |
| doi_str_mv | 10.1371/journal.pone.0079246 |
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Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched to identify relevant studies published until April 2012, supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Of the 6.258 articles retrieved, 13 RCTs (4207 patients) were included. Random effects model was applied to estimate the pooled results.
Telemedicine was associated with a statistically significant and clinically relevant absolute decline in HbA1c level compared to control (mean difference -0.44% [-4.8 mmol/mol] and 95% confidence interval [CI] -0.61 to -0.26% [-6.7 to -2.8 mmol/mol]; p<0.001). LDL-c was reduced in 6.6 mg/dL (95% CI -8.3 to -4.9; p<0.001), but the clinical relevance of this effect can be questioned. No effects of telemedicine strategies were seen on systolic (-1.6 mmHg and 95% CI -7.2 to 4.1) and diastolic blood pressure (-1.1 mmHg and 95% CI -3.0 to 0.8). The 2 studies that assessed the effect on BMI demonstrated a tendency of BMI reduction in favor of telemedicine.
Telemedicine strategies combined to the usual care were associated with improved glycemic control in diabetic patients. No clinical relevant impact was observed on LDL-c and blood pressure, and there was a tendency of BMI reduction in diabetes patients who used telemedicine, but these outcomes should be further explored in future trials.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0079246</identifier><identifier>PMID: 24250826</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Blood ; Blood Glucose ; Blood Pressure ; Body mass ; Body Mass Index ; Body size ; Cholesterol ; Cholesterol, LDL - blood ; Clinical trials ; Confidence intervals ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - physiopathology ; Diabetes Mellitus - therapy ; Diabetes therapy ; Diabetics ; Glucose ; Glycated Hemoglobin A - metabolism ; Glycosylated hemoglobin ; Health care ; Hemoglobin ; Hospitals ; Humans ; Impact analysis ; Information technology ; Intervention ; Low density lipoprotein ; Low density lipoproteins ; Medical research ; Medicine, Experimental ; MEDLINE ; Meta-analysis ; Patients ; Randomized Controlled Trials as Topic ; Reduction ; Statistical analysis ; Studies ; Systematic review ; Telemedicine ; Telemedicine - methods ; Trans fatty acids</subject><ispartof>PloS one, 2013-11, Vol.8 (11), p.e79246-e79246</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013 Marcolino et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2013 Marcolino et al 2013 Marcolino et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-9fa2d03f7535f6d514f149c9e21cb91540729102b51dd9c0bb30f5ddd2ad68e3</citedby><cites>FETCH-LOGICAL-c692t-9fa2d03f7535f6d514f149c9e21cb91540729102b51dd9c0bb30f5ddd2ad68e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826722/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826722/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24250826$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marcolino, Milena Soriano</creatorcontrib><creatorcontrib>Maia, Junia Xavier</creatorcontrib><creatorcontrib>Alkmim, Maria Beatriz Moreira</creatorcontrib><creatorcontrib>Boersma, Eric</creatorcontrib><creatorcontrib>Ribeiro, Antonio Luiz</creatorcontrib><title>Telemedicine application in the care of diabetes patients: systematic review and meta-analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The impact of telemedicine application on the management of diabetes patients is unclear, as the results are not consistent among different studies. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of telemedicine interventions on change in hemoglobin A1c (HbA1c), blood pressure, LDL cholesterol (LDL-c) and body mass index (BMI) in diabetes patients.
Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched to identify relevant studies published until April 2012, supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Of the 6.258 articles retrieved, 13 RCTs (4207 patients) were included. Random effects model was applied to estimate the pooled results.
Telemedicine was associated with a statistically significant and clinically relevant absolute decline in HbA1c level compared to control (mean difference -0.44% [-4.8 mmol/mol] and 95% confidence interval [CI] -0.61 to -0.26% [-6.7 to -2.8 mmol/mol]; p<0.001). LDL-c was reduced in 6.6 mg/dL (95% CI -8.3 to -4.9; p<0.001), but the clinical relevance of this effect can be questioned. No effects of telemedicine strategies were seen on systolic (-1.6 mmHg and 95% CI -7.2 to 4.1) and diastolic blood pressure (-1.1 mmHg and 95% CI -3.0 to 0.8). The 2 studies that assessed the effect on BMI demonstrated a tendency of BMI reduction in favor of telemedicine.
Telemedicine strategies combined to the usual care were associated with improved glycemic control in diabetic patients. No clinical relevant impact was observed on LDL-c and blood pressure, and there was a tendency of BMI reduction in diabetes patients who used telemedicine, but these outcomes should be further explored in future trials.</description><subject>Blood</subject><subject>Blood Glucose</subject><subject>Blood Pressure</subject><subject>Body mass</subject><subject>Body Mass Index</subject><subject>Body size</subject><subject>Cholesterol</subject><subject>Cholesterol, LDL - blood</subject><subject>Clinical trials</subject><subject>Confidence intervals</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - physiopathology</subject><subject>Diabetes Mellitus - therapy</subject><subject>Diabetes therapy</subject><subject>Diabetics</subject><subject>Glucose</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>Glycosylated hemoglobin</subject><subject>Health care</subject><subject>Hemoglobin</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Impact analysis</subject><subject>Information technology</subject><subject>Intervention</subject><subject>Low density lipoprotein</subject><subject>Low density lipoproteins</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>MEDLINE</subject><subject>Meta-analysis</subject><subject>Patients</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Reduction</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Systematic review</subject><subject>Telemedicine</subject><subject>Telemedicine - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marcolino, Milena Soriano</au><au>Maia, Junia Xavier</au><au>Alkmim, Maria Beatriz Moreira</au><au>Boersma, Eric</au><au>Ribeiro, Antonio Luiz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Telemedicine application in the care of diabetes patients: systematic review and meta-analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2013-11-08</date><risdate>2013</risdate><volume>8</volume><issue>11</issue><spage>e79246</spage><epage>e79246</epage><pages>e79246-e79246</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The impact of telemedicine application on the management of diabetes patients is unclear, as the results are not consistent among different studies. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of telemedicine interventions on change in hemoglobin A1c (HbA1c), blood pressure, LDL cholesterol (LDL-c) and body mass index (BMI) in diabetes patients.
Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched to identify relevant studies published until April 2012, supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Of the 6.258 articles retrieved, 13 RCTs (4207 patients) were included. Random effects model was applied to estimate the pooled results.
Telemedicine was associated with a statistically significant and clinically relevant absolute decline in HbA1c level compared to control (mean difference -0.44% [-4.8 mmol/mol] and 95% confidence interval [CI] -0.61 to -0.26% [-6.7 to -2.8 mmol/mol]; p<0.001). LDL-c was reduced in 6.6 mg/dL (95% CI -8.3 to -4.9; p<0.001), but the clinical relevance of this effect can be questioned. No effects of telemedicine strategies were seen on systolic (-1.6 mmHg and 95% CI -7.2 to 4.1) and diastolic blood pressure (-1.1 mmHg and 95% CI -3.0 to 0.8). The 2 studies that assessed the effect on BMI demonstrated a tendency of BMI reduction in favor of telemedicine.
Telemedicine strategies combined to the usual care were associated with improved glycemic control in diabetic patients. No clinical relevant impact was observed on LDL-c and blood pressure, and there was a tendency of BMI reduction in diabetes patients who used telemedicine, but these outcomes should be further explored in future trials.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24250826</pmid><doi>10.1371/journal.pone.0079246</doi><tpages>e79246</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Blood Blood Glucose Blood Pressure Body mass Body Mass Index Body size Cholesterol Cholesterol, LDL - blood Clinical trials Confidence intervals Diabetes Diabetes mellitus Diabetes Mellitus - physiopathology Diabetes Mellitus - therapy Diabetes therapy Diabetics Glucose Glycated Hemoglobin A - metabolism Glycosylated hemoglobin Health care Hemoglobin Hospitals Humans Impact analysis Information technology Intervention Low density lipoprotein Low density lipoproteins Medical research Medicine, Experimental MEDLINE Meta-analysis Patients Randomized Controlled Trials as Topic Reduction Statistical analysis Studies Systematic review Telemedicine Telemedicine - methods Trans fatty acids |
| title | Telemedicine application in the care of diabetes patients: systematic review and meta-analysis |
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