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

doi:10.4239/wjd.v12.i2.170

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World Journal of Diabetes

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Meta-Analysis

World J Diabetes. Feb 15, 2021; 12(2): 170-197
Published online Feb 15, 2021. doi: 10.4239/wjd.v12.i2.170

Table 3 HbA1c subgroup analysis for included studies

Subgroups	Studies (n)	Participant (n)	Mean difference			Effect size
	Studies (n)	Participant (n)	Q test	Mean difference (95%CI)	I² (%)	Q test	Effect size (95%CI)	I² (%)
Mode of intervention
Text message	5	469	55.331	-0.591 (-0.892, -0.290)^c	92.771^c	133.957	-1.377 (-2.503, -0.252)^a	97.014^c
Mobile app	12	1154	321.220	-0.359 (-0.502, -0.215)^c	96.576^c	281.110	-1.308 (-2.009, -0.607)^c	96.087^c
Interactive telephone	2	170	9.069	-0.782 (-1.172, -0.391)^c	88.974b	2.226	-2.600 (-3.243, -1.957)^c	55.074
Internet server/computer network	7	1288	353.994	-0.431 (-0.558, -0.304)^c	98.305^c	332.245	-1.751 (-2.819, -0.684)^c	98.194^c
Website	14	1875	843.158	-0.539 (-0.706, -0.371)^c	98.458^c	696.131	-1.747 (-2.587, -0.907)^c	98.133^c
Video conference	2	164	1.687	-0.845 (-1.144, -0.546)^c	40.719	25.261	-1.450 (-3.323, 0.424)	96.041^c
Device or tablet	5	1812	332.123	-0.278 (-0.747, 0.191)^c	98.796^c	162.677	-0.905 (-1.725, -0.085)^a	97.541^c
Duration of intervention, months
≤ 6	6	1158	222.519	-0.363 (-0.567, -0.159)^c	97.753^c	239.478	-1.290 (-2.186, -0.394)^b	97.912^c
6	20	2234	1260.455	-0.626 (-0.766, -0.486)^c	98.493^c	740.442	-2.054 (-2.712, -1.396)^c	97.434^c
> 6	21	2565	1173.100	-0.380 (-0.507, -0.252)^c	98.295^c	674.872	-1.080 (-1.583, -0.578)^c	97.036^c
Focus of intervention
Biomedical parameters	16	2633	1830.624	-0.687 (-0.821, -0.553)^c	99.181^c	844.645	-2.406 (-3.174, -1.639)^c	98.224^c
Self-management behaviors	7	334	64.189	-0.360 (-0.805, 0.086)	90.653^c	139.861	-0.740 (-1.753, 0.274)	95.710^c
Biomedical and self-management	24	3965	687.693	-0.348 (-0.442, -0.253)^c	96.655^c	645.659	-1.171 (-1.583, -0.759)^c	96.438^c
Telemedicine method
Telemonitoring	19	3076	1872.902	-0.553 (-0.662, -0.445)^c	99.039c	1107.777	-2.263 (-2.991, -1.534)^c	98.375^c
Tele-education	12	994	125.448	-0.495 (-0.683, -0.307)^c	91.231c	289.370	-1.068 (-1.767, -0.368)^b	96.199^c
Telemonitoring and tele-education	16	2862	501.993	-0.391 (-0.542, -0.240)^c	97.012c	287.276	-1.002 (-1.415, -0.588)^c	94.779^c
Model of intervention
Behavior change	28	2773	629.401	-0.452 (-0.575, -0.329)^c	95.710^c	596.338	-1.041 (-1.426, -0.656)^c	95.472^c
Treatment	13	2248	1518.194	-0.589 (-0.725, -0.453)^c	99.210^c	710.693	-2.386 (-3.249, -1.522)^c	98.312^c
Behavior change and treatment	6	1911	448.804	-0.401 (-0.612, -0.189)^c	98.886^c	332.288	-1.934 (-3.070, -0.799)^c	98.495^c
Intervention lead
Doctor	11	987	522.974	-0.288 (-0.512, -0.064)^a	98.088^c	391.153	-0.922 (-1.795, -0.048)^a	97.443^c
Nurse	15	2747	868.940	-0.491 (-0.655, -0.327)^c	98.389^c	474.130	-1.606 (-2.205, -1.006)^c	97.047^c
Multi-disciplinary	17	2941	1237.843	-0.534 (-0.643, -0.425)^c	98.707^c	852.270	-2.038 (-2.702, -1.375)^c	98.123^c
Allied health	4	257	8.094	-0.939 (-1.651, -0.227)^b	62.935^a	11.197	-0.600 (-1.137, -0.062)^a	73.208^b
Dropout rate
0%-9.9%	20	2659	779.280	-0.458 (-0.584, -0.333)^c	97.562^c	571.285	-1.138 (-1.62, -0.657)^c	96.674^c
10%-19.9%	16	2795	709.022	-0.645 (-0.786, -0.504)^c	97.884^c	740.889	-2.329 (-3.107, -1.552)^c	97.975^c
20% +	10	994	365.413	-0.297 (-0.472, -0.121)^c	97.537^c	267.256	-0.902 (-1.632, -0.171)^a	96.632^c
Frequency of intervention
Daily	19	2176	996.897	-0.439 (-0.577, -0.302)^c	98.194^c	593.016	-1.408 (-1.959, -0.857)^c	96.965^c
< daily to > weekly	10	2005	627.889	-0.307 (-0.462, -0.152)^c	98.567^c	602.249	-1.452 (-2.300, -0.605)^c	98.506^c
Weekly	7	1095	448.790	-0.791 (-1.167, -0.416)^c	98.663^c	353.155	-2.340 (-3.576, -1.105)^c	98.301^c
< weekly	5	1162	30.212	-0.835 (-1.068, -0.602)^c	86.760^c	131.622	-2.423 (-3.943, -0.902)^b	96.961^c
Not mentioned	6	494	33.795	-0.227 (-0.690, 0.237)	85.205^c	42.744	-0.360 (-1.010, 0.290)	88.302^c
Rate of use/engagement
≤ 70%	5	808	406.483	-0.212 (-0.526, 0.102)	99.016^c	254.620	-1.060 (-2.422, 0.303)	98.429^c
> 70%	8	1287	150.709	-0.576 (-0.696, -0.455)^c	95.355^c	204.974	-2.492 (-3.514, -1.469)^c	96.585^c
Not mentioned	34	4837	1782.085	-0.496 (-0.589, -0.403)^c	98.148^c	1231.652	-1.361 (-1.771, -0.951)^c	97.321^c
Self-care: Medication adherence
No significant differences	4	557	57.285	-0.268 (-0.459, -0.077)^b	94.763^c	39.413	-0.650 (-1.254, -0.047)^a	92.388^c
Intervention significantly better	3	541	22.004	-0.265 (-0.677, 0.147)	90.911^c	60.687	-0.783 (-1.810, 0.245)	96.704^c
Not mentioned	40	5834	2414.200	-0.522 (-0.605, -0.44)^c	98.385^c	1538.553	-1.664 (-2.09, -1.237)^c	97.465^c
Self -care: Disease knowledge
No significant differences	7	685	33.269	-0.025 (-0.169, 0.118)	81.965^c	39.012	-0.142 (-0.535, 0.252)	84.620^c
Intervention significantly better	2	197	5.253	-0.590 (-1.401, 0.222)	80.963^a	42.653	-1.220 (-3.543, 1.102)	97.655^c
Not mentioned	38	6050	2399.254	-0.530 (-0.611, -0.449)^c	98.458^c	1584.253	-1.802 (-2.234, -1.37)^c	97.655^c
Self-care: Behavior change
No significant differences	3	379	0.374	-0.100 (-0.134, -0.065)^c	0.000	10.944	-0.318 (-0.769, 0.132)	81.726^c
Intervention significantly better	4	328	94.795	-0.532 (-1.153, 0.090)	96.835^c	70.276	-1.145 (-2.347, 0.057)	95.731^c
Not mentioned	40	6225	2477.596	-0.508 (-0.59, -0.427)^c	98.426^c	1678.368	-1.656 (-2.079, -1.234)^c	97.676^c
Self-care: Glucose monitoring
No significant differences	1	299	0.000	-0.100 (-0.136, -0.064)^c	0.000	0.000	-0.634 (-0.866, -0.401)^c	0.000
Intervention significantly better	3	434	103.754	-0.505 (-0.923, -0.087)^a	98.072^c	31.471	-1.795 (-2.897, -0.693)^c	93.645^c
Not mentioned	43	6199	2441.038	-0.498 (-0.580, -0.416)^c	98.279^c	1807.229	-1.527 (-1.942, -1.113)^c	97.676^c
Self-care: Hospital visits needed
No significant differences	2	339	29.741	-0.440 (-0.744, -0.137)^b	96.638^c	0.510	-2.467 (-2.750, -2.184)^c	0.000
Intervention significantly better	1	246	0.000	0.010 (-0.023, 0.043)	0.000	0.000	0.082 (-0.187, 0.351)	0.000
Not mentioned	44	6347	2341.454	-0.505 (-0.586, -0.424)^c	98.164^c	1692.930	-1.519 (-1.906, -1.133)^c	97.460^c
Self-care: self-efficacy
No significant differences	6	1071	90.786	-0.232 (-0.360, -0.105)^c	94.493^c	71.592	-0.636 (-1.093, -0.178)^b	93.016^c
Intervention significantly better	1	47	0.000	-0.810 (-1.013, -0.607)^c	0.000	0.000	-2.290 (-3.029, -1.552)^c	0.000
Not mentioned	40	5814	2311.342	-0.514 (-0.597, -0.430)^c	98.313^c	1633.909	-1.638 (-2.077, -1.199)^c	97.613^c
Self-care: nutrition
No significant differences	4	380	42.368	-0.642 (-0.845, -0.440)^c	92.919^c	7.474	-2.190 (-2.608, -1.772)^c	59.861
Not mentioned	43	6552	2567.224	-0.466 (-0.546, -0.387)^c	98.364^c	1785.184	-1.457 (-1.853, -1.061)^c	97.647^c
Self-care: Exercise
No significant differences	2	132	7.605	-0.641 (-0.943, -0.338)^c	86.850^b	0.209	-2.427 (-2.877, -1.976)^c	0.000
Not mentioned	45	6800	2636.871	-0.477 (-0.554, -0.400)^c	98.331c	1824.510	-1.485 (-1.866, -1.104)^c	97.588^c
Racial
Hispanic	2	148	2.118	-0.867 (-1.052, -0.682)^c	52.782	0.502	-2.791 (-3.245, -2.337)^c	0.000
Not mentioned	45	6784	2560.239	-0.464 (-0.540, -0.388)^c	98.281^c	1804.224	-1.471 (-1.85, -1.092)^c	97.561^c
Comorbid disease
Overweight/obese	4	318	50.425	-1.270 (-1.971, -0.568)^c	94.051^c	50.979	-2.034 (-3.280, -0.788)^c	94.115^c
Hypertension	1	299	0.000	-0.100 (-0.136, -0.064)^c	0.000	0.000	-0.634 (-0.866, -0.401)^c	0.000
Not mentioned	42	6315	2376.371	-0.439 (-0.516, -0.361)^c	98.275^c	1787.062	-1.499 (-1.910, -1.087)^c	97.706^c

Allied health, diabetes educator, dietician, councillor.

^aP < 0.05.

^bP < 0.01.

^cP < 0.001. CI: Confidence interval.

Citation: De Groot J, Wu D, Flynn D, Robertson D, Grant G, Sun J. Efficacy of telemedicine on glycaemic control in patients with type 2 diabetes: A meta-analysis. World J Diabetes 2021; 12(2): 170-197
URL: https://www.wjgnet.com/1948-9358/full/v12/i2/170.htm
DOI: https://dx.doi.org/10.4239/wjd.v12.i2.170