Meta-analysis of telemonitoring to improve HbA1c levels: Promise for stroke survivors
Abstract
Monitoring glycemic control is useful not only in the primary prevention of stroke in diabetics, but also in the rehabilitation from and secondary prevention of stroke. In an often functionally and neurocognitively impaired population, however, poor compliance with treatment regimens is a major problem. Wireless, telemonitoring glucometers - often integrated into the patient's healthcare system - offer a solution to the compliance issue. We sought to evaluate the effectiveness of telemonitoring technologies in improving long-term glycemic control. A search on www.clinicaltrials.gov, using keywords such as "telemonitoring" and "self-care device" was performed, and five trials were identified that compared hemoglobin A1c (HbA1c) levels of a group receiving standard care (controls) to a group receiving a telemonitoring intervention. Four of the five studies showed a greater reduction in HbA1c in the intervention group compared to controls at 6 months, although only one was statistically significant. There was considerable heterogeneity between studies (I(2)=69.5%, p=0.02), and the random effects model estimated the aggregate effect size for mean difference in reduction of HbA1c levels to be 0.08% (95% confidence interval -0.12% to 0.28%), which was not statistically significant (p=0.42). The varying results may be due to specific factors in the trials that contributed to their large heterogeneity, and further trials are needed to support the role of telemonitoring in improving diabetes management in this population. Nonetheless, in the future telemonitoring may substantially help patients at risk of ischemic stroke and those who require close glucose monitoring.
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Other 1-star narrative syntheses showed no overall benefit from teleconsultations or telemonitoring.
“Three 1-star narrative syntheses suggested improved outcomes with mobile phone interventions [32,35,36], but others showed no overall benefit from teleconsultations [47,51] or telemonitoring [34,39].”
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- Authors
- Lieber, B. A., Taylor, B., Appelboom, G., Prasad, K., Bruce, S., Yang, A., Bruce, E., Christophe, B., & Connolly, E. S.
- Affiliations
- New York University (US)
- Columbia University Irving Medical Center (US)
- Columbia University (US)
- ORCID
- Venue
- Journal of Clinical Neuroscience
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 22
- Issue
- 5
- Pages
- 807-811
- ISSN
- 0967-5868 (ISSN-L)
- OpenAlex
- W2136531290
- Cited by
- 25
- References
- 47
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 4 · 2022: 1 · 2021: 3 · 2020: 1 · 2019: 1 · 2018: 6 · 2017: 4 · 2016: 3
- FWCI
- 0.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- remote patient monitoring, HbA1c, glycemic control, stroke survivors, diabetes management, medication adherence, secondary stroke prevention, ischemic stroke, telemedicine
- MeSH terms
- Blood Glucose, Clinical Trials as Topic, Diabetes Mellitus, Glycated Hemoglobin, Humans, Male, Middle Aged, Self Care, Telemedicine, Survivors, Stroke
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