Efficacy of telemedicine on glycaemic control in patients with type 2 diabetes: A meta-analysis

Table 1 The characteristics of included studies (require insert reference for each study)

Ref.	Number centres, funding	Participants I/C	Design, location (country/territory)	Mean age intervention (SD)/mean age control (SD) (yr)	Sex (M/F)	Intervention type	Control	Measured outcomes	Key results	PEDro	Notes
Alanzi et al[36] 2018	4, none stated	10/10	NB, Saudi Arabia	8 × (18-40), 2 × (41-50)/9 × (18-40), 1 × (41-50)	15/5	Mobile application; Bluetooth transmission of blood glucose, social networking, cognitive behavioral therapy (6 mo)	Usual care	HbA1c	Greater decrease in HbA1c for intervention vs control	5	-
Arora et al[37] 2014	1, Agile Health LLC and McKesson foundation	64/64	NB, United States	50.5 (10.3)/51 (10.2)	46/82	Twice daily text messages about self-care and medication adherence (6 mo)	Usual care	HbA1c	No significant differences	4	Data converted from median (range)a
Bujnowska-Fedak et al[38] 2011	Multi-centre, none stated	50/50	NB, Poland	53.1 (25.2)/57.5 (27.4)	51/44	Transmission of blood glucose to computer network via glucometer, systems sends text to GP (6 mo)	Usual care with glucometer	HbA1c, FPG, PPG, BMI, SBP, DBP, TC	No significant differences	5	-
Cho et al[39] 2017	3, Korean Government	244/240	NB, South Korea	52.9 (9.2)/53.4 (8.7)	307/177	Glucometer and blood pressure measurements sent via internet connected device, doctors and nurses send back recommendations (6 mo)	Usual care	HbA1c, FPG, weight, BMI, SBP, DBP, TC, HDL, LDL, TG, WC, PPG, QoL	Greater decrease in HbA1c, PPG and WC for intervention vs control	6	-
Crowley et al[40] 2016	1, Veterans Affairs	25/25	NB, United States	60 (8.4)/60 (9.2)	48/2	Glucose testing sent via telephone voice system daily + fortnightly self-management modules via telephone (6 mo)	Usual care	HbA1c, SBP, DBP, Depression	Greater decrease in HbA1c, SBP, DBP for intervention vs control	6	-
Dafoulas et al[41] 2015	Multicentre, European Community	74/80	SB, Greece	58.28 (0.93)/64.11 (0.6)	68/86	Transmission of blood glucose weekly via mobile app + calls from doctors as required (12 mo)	Usual care	HbA1c, QoL	Greater decrease in HbA1c, QoL physical, QoL mental and physical activity for intervention vs control	5	-
Dario et al[42] 2017	3, European Commission and RENEWING HEALTH project	208/91	NB, Italy	73.05 (5.79)/73.04 (5.28)	168/131	Transmission of glucometer via online gateway to doctor	Usual care	HbA1c, QoL, depression, anxiety	No significant differences	5	-
Fortmann et al[43] 2017	4, Mckesson foundation and National center for advancing translational sciences grant	63/63	NB, United States	47.8 (9.0)/49.1 (10.6)	32/94	Text messages, up to 3 per day; motivational, educational or call-to-action (6 mo)	Usual care	HbA1c, FPG, TC, HDL, LDL, TG, SBP, DBP, BMI, weight	Greater decrease in HbA1c for intervention vs control	6	-
Fountoulakis et al[44] 2015	2, None stated	54/26	NB, Greece	61.3 (11.4)/63.5 (13.8)	55/25	USB-connected modem compatible with glucometer, data transmitted to computers of Department of Endocrinology	Usual care	HbA1c, BMI	Greater decrease in HbA1c for intervention vs control	5	Separates T1D and T2D data. Recruitment ‘n’ not provided
Holmen et al[45] 2014	2, European Union + 6 others	(1) 51/50, (2) 50/50	NB, Norway	58.6 (11.8)/55.9 (12.2)	(1) 64/37, (2) 55/45	(1) mobile phone based self-management system app (automatic blood glucose transmission, input of diet and exercise info, goal managing). (2) Intervention 1 + telephone behaviour-change counselling from nurse for first 4 mo (12 mo)	Usual care	HbA1c, weight	No significant differences	5	3 arm (2 interventions)
Jeong et al[46] 2018	4, Ministry of Health and Welfare, Republic of Korea and Ministry of Trade, Industry, and Energy South Korea	(1) 113/113, (2)112/113	NB, South Korea	53.65 (9.10)/53.16 (9.06)	(1) 64/37, (2) 55/45	(1) telemonitoring: outpatient clinic + tablet unit with auto blood glucose and weight transmission, diet and exercise monitoring with automated feedback texts. (2) telemedicine: intervention 1 + videoconference outpatient clinic (24 wk)	Usual care	HbA1c, FPG, PPG, BMI, body weight, SBP, DBP, HDL, LDL, TG	Greater decrease in FPG for (1) telemonitoring group and (2) telemedicine group vs control	6	3 arm (2 interventions)a
Kempf et al[47] 2017	Multicentre, Boehringer Ingelheim International and University Dusseldorf	102/100	SB, Germany	59 (9)/60 (8)	90/77	Glucometer, weight and pedometer data auto uploaded to online portal + weekly phone calls about lifestyle change and self-management (12 wk, 52 wk follow-up data)	Usual care with self-management guide, scale and step counter	HbA1c, FPG, weight, BMI, SBP, DBP, TC, HDL, LDL, QoL	Greater decease in HbA1c, body weight, BMI, SBP and QoL for intervention vs control	8	TG excluded as median (IQR) and skewed
Kim et al[48] 2007	1, College of Nursing Catholic University of Korea	30/30	NB, Korea	46.8 (8.8)/47.5 (9.1)	22/29	Self-monitored glucose and medication use was submitted online and weekly recommendations were sent via text (6 mo)	Usual care	HbA1c, FPG, PPG	Greater decrease in PPG for intervention vs control	5	-
Kim et al[49] 2008	1, Korean Government	20/20	NB, Korea	45.5 (9.1)/48.5 (8)	16/18	Medications and self-monitored glucose readings were used to create online medical record + weekly recommendations sent via text message (12 mo)	Usual care	HbA1c, FPG, PPG	Greater decrease in HbA1c for intervention vs control	5	-
Kim et al[50] 2016	1, UB care	110/110	NB, China	52.5 (9.1)/55.6 (10)	88/94	Internet-based self-monitoring of blood glucose + recommendations via a website (6 mo)	Usual care	HbA1c, SBP, DBP, TC, TG, HDL, LDL	Greater decrease in HbA1c and FPG for intervention vs control	4	-
Kim et al[51] 2019	3, HealthConnect Co.	97/94	NB, South Korea	60 (8.4)/56.7 (9.1)	99/73	Smartphone modules for Bluetooth glucometer, diet, exercise via activity tracker + clinical decision support (24 wk)	Usual care + Manual glucose logbook	HbA1c, FPG, weight, SBP, DBP, TC, TG, LDL, HDL	Greater decrease in HbA1c for intervention vs control	5	a
Kleinman et al[52] 2017	3, Gather Health LLC	44/46	NB, India	48.8 (9)/48 (9.5)	63/27	Mobile app provided daily reminders for self-management tasks and data + provider communication and treatment adjustment (6 mo)	Usual care	HbA1c, FPG, BMI	Greater decrease in HbA1c, greater increase self-reported medication adherence and BG testing for intervention vs control	7
Lee et al[53] 2020	11, Ministery of Science, Technology and Innovation Malaysia	120/120	SB, Malaysia	56.1 (9.2)/56.3 (8.6)	108/132	Auto transmission of glucometer data via online portal with automatic feedback + team encouraged self-management monthly + change to medication if required (12 mo)	Usual care	HbA1c, FPG, SBP, DBP, TC, TG, HDL, LDL, QoL	Greater decrease in HbA1c for intervention vs control	7	a
Lim et al[54] 2016	1, Korea healthcare technology R&D project	50/50	NB, Korea	64.3 (5.2)/65.8 (4.7)	75/25	Bluetooth glucometer and activity monitor, and dietary and exercise transmission to website + tailored feedback to device or mobile (6 mo)	Usual care + self monitored blood glucose	HbA1c, BMI, SBP, DBP, TC, TG, LDL, HDL, WC, FPG, PPG	Greater decrease in HbA1c for intervention vs control	5	-
Liou et al[55] 2014	6, none stated	54/41	NB, Taiwan	56.6 (7.7)/57 (7.5)	48/47	6 sessions about diet, medication, stress management, goal setting and foot care, including 2 via teleconference (6 mo)	Usual care + 1 in-person education session by nurse	HbA1c, BMI, SBP, DBP, TC, TG, LDL, HDL	Greater decrease in HbA1c for intervention vs control	5	TG excluded as log-transformeda
Luley et al[56] 2011	1, none stated	35/35	NB, Germany	59 (9)/58 (7)	34/36	Bluetooth transmission from scales and accelerometer via Homebox to server + weekly feedback and progress via letters + low calorie diet (6 mo)	Usual care + conventional low fat diet	Weight, BMI, HBA1c, TG, HDL, FPG	Greater decrease in HbA1c weight, BMI and FPG for intervention vs control	5	a
Nicolucci et al[57] 2015	Multi-centre, MSD Italia grant	153/149	NB, Italy	59.1(10.3)/57.8(8.9)	94/92	Bluetooth transmission weight, blood glucose and blood pressure measurements to server via internet + remote support and GP feedback	Usual care	HbA1c, weight, SBP, DBP, TC, HDL, LDL, TG, QoL	Greater decrease of HbA1c and increase of mental summary QoL for intervention vs control	4	-
Or et al[58] 2020	1, Food and Health Bureau	151/148	NB, Hong Kong	63.9 (10.2)/63.7 (9.6)	192/107	Bluetooth glucometer and BP monior + website-based technological surrogate nursing care encouraged self-management via tablet with resources (24 wk)	Usual care	HbA1c, SBP, DBP	No significant differences	7	-
Orsama et al[59] 2013	1, Finnish funding agency, Technical Research centre Finland & Bayer HealthCare	27/29	NB, Finland	62.3 (6.5)/61.5 (9.1)	26/22	Mobile app transmission of weight, blood glucose, stepcount and blood pressure + automatic feedback with behaviour change focus + website viewing of health record	Usual care	HbA1c, weight, SBP, DBP	Greater decrease in HbA1c and weight for intervention vs control	5	Baseline HbA1c up to 2 months were used
Pacaud et al[60] 2012	1, Lawson Foundation	(1) 18/21, (2) 29/21	NB, Canada	52.1 (8.8)/56.3 (8.1)	(1) 10/8, (2) 12/17	(1) Webstatic: email consults (12 mo). 1A-male, 1B-female. (2) Web Interactive: online chat and email consults. 2A-male, 2B-female. (12 mo)	Usual care + education (face-to-face education, group sessions)	HbA1c, QoL	No significant differences	5	5 arm (2 interventions and separation by sex). Post-test 'n 'not givena
Pressman et al[61] 2014	Multi-centre, Samsung	118/107	SB, America	54.8 (9.8)/56.4 (8.7)	122/76	Weekly transmission of blood glucose, blood pressure and weight to case manager via device + tailored telephone feedback (6 mo)	Usual care	Weight, BMI, SBP, LDL, HbA1c	No significant differences	6	a
Quinn et al[62] 2016	Multi-centre, University of Maryland and WellDoc	(1) 37/29, (2) 25/27	NB, United States	47.3 (6.8)/47.4 (7.5)	(1) 32/34, (2) 27/25	Mobile phone coaching App, entering blood glucose, diet, medication info with behavioural, motivation or feedback messages + Web portal (12 mo)	Usual care	HbA1c	Greater decease in HbA1c for intervention vs control, no statistical difference for age groups	4	3 arm (separated by age < 55 and > 55)
Ramadas et al[63] 2018	3, Monash University	66/62	NB, Malaysia	49.6 (10.7)/51.5 (10.3)	77/51	Web-based nutrition lesson plan and dietary intervention (12 mo)	Usual care	FBG, HbA1c	No significant differences	7	Mean difference provided by study for HbA1ca
Rodríguez-Idígoras et al[64] 2009	Multi-centre, Roche Diagnostics Spain	161/167	NB, Spain	63.32 (11.13)/64.52 (10.32)	169/159	Transmission of glucometer data via mobile + mobile contact by patient or healthcare staff when required + teleconsults (12 mo)	Usual care	HbA1c	Greater decrease in HbA1c for intervention vs control	7	-
Shea et al[65] 2009	2, Medicare and Medicaid + 6 more	844/821	SB, United States	70.8 (6.5)/ 70.9 (6.8)	616/1049	Home unit with web-enabled computer access to website with education + webcam for videoconferencing + auto uploading glucometer and blood pressure data (5 yr)	Usual care	HbA1c, LDL, SBP, DBP	Greater decrease in HbA1c (years 4-5) and LDL (years 1-4) and SBP (years 1-5) and DBP (years 1-5) for intervention vs control	5	Changed from Weinstock 2011, Adjusted mean used
Stone et al[66] 2010	Multi-centre, U.S. Air Force	64/73	SB, United States	3 × (< 45), 38 × (45-65), 23 × (> 65)/4 × (< 45), 43 × (45-65), 26 × (> 65)	135/2	Transmission of blood glucose, blood pressure and weight via internet-connected device + monthly phone calls: self-management education, medication changes (6 mo)	Monthly phone call	HbA1c, weight, SBP, DBP, TC, HDL, LDL, TG	Greater decrease in HbA1c for intervention vs control	7	-
Sun et al[67] 2019	1, Science Technology Department Jilin and Jilin University	44/47	NB, China	67.9 (66,71), 68.04 (66, 72) Median (IQR)	37/54	Mobile phone application + Bluetooth glucometer + advice every 2 wk via app (6 mo)	Usual care + glucometer + outpatient visits	HbA1c, PPG, FPG, TC, TG, BMI, SBP	Greater decrease in HbA1c and PPG for intervention vs control	5	HDL, LDL, BMI, DBP excluded due to median (IQR) and skewed
Tang et al[68] 2013	1, Agency for Health Research and Quality	193/189	SB, United States	54 (10.7)/53.5 (10.2)	249/166	Bluetooth glucometer readings + uploaded nutrition, exercise logs, insulin record online + messages with healthcare team and personalised text and video	Usual care	HbA1c, LDL, weight, SBP, DBP	No significant differences at 12 mo, but greater decrease in HbA1c at 6 months of intervention vs control	7	-
Vinitha et al[69] 2019	5, AstraZeneca Pharma India Ltd	126/122	NB, India	42.4 (8.5)/44.1 (8.9)	168/80	Text messages 3 times weekly: education, lifestyle, medication (24 mo)	Usual care	HbA1c, weight, BMI, WC, SBP, DBP, FPG, PPG, TC, HDL, LDL, QoL	Greater decrease in HbA1c, SBP and FPG for intervention vs control	6	TG excluded due to median (IQR) and skewed
Wang et al[70] 2017	1, Science Technology Department Jilin	106/106	NB, China	52.6 (9.1)/54.7 (10.3)	116/104	Transfer of glucometer data to health centre via website + receival of information/advice (6 mo)	Usual care	HbA1c, TC, HDL, LDL	Greater decrease in HbA1c, PPG, FPG and TG for intervention vs control	4	FPG, TG, BMI, SBP, DBP, PPG excluded due to median (IQR) and skewed
Wang et al[71] 2018	1, National Center for Clinical and Translational Sciences grant	11/6	NB, United States	58.8 (5.9)/49.2 (10.2)	7/10	Smartphone application + Bluetooth scale and glucometer + 12 in-person behaviour-change sessions (6 mo)	Usual care	HbA1c	Greater decrease in HbA1c for intervention vs control	5	Paper group intervention not included here
Wayne et al[72] 2015	2, Public Health Agency Canada	67/64	NB, Canada	53.1 (10.9)/53.3 (11.9)	28/72	Mobile phone monitoring and health coaching (6 mo)	Health coaching without mobile	HbA1c, weight, WC, BMI, depression, anxiety, QoL	Greater decrease in BMI and greater increase in QoL (Mental SF-12) for intervention vs control	5	-
Welch et al[73] 2011	1, Baystate Medical Center	25/21	NB, United States	54.4 (10.4)/57.5 (9.5)	31/15	Transmission of comprehensive patient data to clinician via internet + 7 in-person visits of 1 h diabetes education (12 mo)	7 in-person visits of 1 h diabetes education	HbA1c, SBP, DBP, BMI	Greater decrease in HbA1c and SBP for intervention vs control	4	Depression excluded due to nil measure of variance
Whittemore et al[74] 2020	5, none stated	26/21	SB, Mexico	53.9 (9.2)/56.8 (8.3)	16/31	7 weekly self-management group sessions + 6 mo daily text messages about behaviour change + unconnected glucometer (6 mo)	Usual care (waitlist for intervention)	HbA1c, SBP, DBP BMI, depression	No significant differences	7	a
Wild et al[75] 2016	4, Chief Scientist Office Grant	160/161	SB, United Kingdom	60.5 (9.8)/61.4 (9.8)	214/107	Bluetooth transmission of glucose, blood pressure and weight to website + called when lifestyle and medication changes required (9 mo)	Usual care	HbA1c, SBP, DBP, weight	Greater decrease in HbA1c, SBP and DBP for intervention vs control	7	-
Williams et al[76] 2012	3, QLD Health, HCF Health and Medical Research Foundation	60/60	NB, Australia	58.4 (8.2)/56.4 (8.3)	76/44	Bluetooth Glucometer + Interactive automated telephone system encouraging self-management behaviours (6 mo)	Usual care	HbA1c, QoL	Greater decrease in HbA1c and improved mental HRQL for intervention vs control	5	-
Xu et al[77] 2020	1, National Institutes of Health, Veterans Affairs	33/32	NB, United States	54.6 (1.82)/55.34 (1.94)	20/44	Glucose data self reported and collected by automated phone calls/texts, shared with providers with bidirectional communication (12 mo)	Usual care	HbA1c	No significant differences	5	Excluded FPG measures as it was patient-reported
Yip et al[78] 2002	1, none stated	41/41	SB, China	55.29 (8.63)/57.54 (8.52)	70/52	4 educational sessions via videoconference + telephone monitoring (4.5 mo). Outcomes measured at 6 mo)	Usual care	HbA1c	No significant differences	5	Additional non-telehealth group not included

^aP < 0.05. SBP: Systolic blood pressure; DBP: Diastolic blood pressure; BMI: Body mass index; TC: Total cholesterol; MD: Mean difference; CI: Confidence interval; FPG: Fastening plasma glucose; WC: Waist circumference; PPG: Post-prandial glucose; QoL: Quality of life.