A systematic review of telemedicine interventions to support blood glucose self‐monitoring in diabetes
Abstract
Aims To evaluate evidence for feasibility, acceptability and cost‐effectiveness of diabetes telemedicine applications. Methods medline,embase,psychinfo,cinahl, Cochrane, and inspec were searched using the terms diabetes and telemedicine for clinical studies using electronic transfer of blood glucose results in people with diabetes. The technology used, trial design and clinical outcome measures used were extracted for trials and prospective cohort studies. Randomized controlled trials with HbA 1c as an outcome were pooled using standard meta‐analytical methods. Results We identified 539 papers among which 32 papers described 10 prospective cohort studies, 12 parallel group randomized controlled trials (RCT), three crossover trials, and one non‐parallel group trial. Only two studies described full details of randomization, blinding of outcomes and dropouts and withdrawals. Electronic transfer of glucose results appears feasible in a clinical setting. Only two of the RCTs included more than 100 patients, and only three extended to 1 year. Only one study was designed to show that telemedicine interventions might replace clinic interventions without deterioration in HbA 1c. Results pooled from the nine RCTs with reported data did not provide evidence that the interventions were effective in reducing HbA 1c(−0.1%, 95% CI −0.4% to 0.04%). Conclusions Telemedicine solutions for diabetes care are feasible and acceptable, but evidence for their effectiveness in improving HbA 1c or reducing costs while maintaining HbA 1c levels, or improving other aspects of diabetes management is not strong. Further research should seek to understand how telemedicine might enhance educational and self‐management interventions and RCTs are required to examine cost‐effectiveness.
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Taking into account quality assessment, explicit self-management focus, and total population size, 8 reviews received an evidence weighting of 3 stars, 23 received 2 stars, 21 received 1 star, and 1 received no stars.
“Taking into account quality assessment, explicit self-management focus, and total population size, 8 reviews received an evidence weighting of 3 stars [16,21,25,26,38,45,53,56], 23 received 2 stars [22,24,27-31, 33,37,40,42,44,46,49,50,52,54,55,58,62,63,67,68], 21 received 1 star [19,20,23,32,34-36,39,43,47,48,51,57, 59-61,64-66,69,70], and 1 received no stars [41].”
Nineteen reviews included both type 1 and 2 diabetes in their analyses, or included RCTs that did not differentiate.
“In total, 19 reviews included both type 1 and 2 diabetes in their analyses, or included RCTs that did not differentiate [16,22,25,27,28,31,32,34-40,44,45,47,50,51].”
Four of the mixed diabetes reviews were awarded a 3-star weighting.
“Of these, 4 were awarded a 3-star weighting [16,25,38,45], of which Farmer et al [25] , Small et al [45], and Liang et al [38] analyzed control or health care utilization outcomes, or both.”
Farmer et al assessed telemonitoring of self-monitored blood glucose and found no significant improvement in HbA1c in a meta-analysis of 9 RCTs, and either no difference or an increase in health care utilization in 6 RCTs.
“Farmer et al assessed telemonitoring of self-monitored blood glucose and found no significant improvement in HbA1c in a meta-analysis of 9 RCTs, and either no difference or an increase in health care utilization in 6 RCTs [25].”
For type 2 diabetes and heart failure, findings were inconsistent between reviews, and analyses of similar interventions reached different conclusions.
“For both of these conditions, however, findings were inconsistent between reviews, and analyses of similar interventions reached different conclusions [25,55,57].”
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- Authors
- Farmer, A., Gibson, O. J., Tarassenko, L., & Neil, A.
- Affiliations
- University of Oxford (GB)
- Churchill Hospital (GB)
- Corresponding author
- Farmer, A.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2005-09-13
- Volume
- 22
- Issue
- 10
- Pages
- 1372-1378
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W2155908428
- Cited by
- 211
- References
- 43
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 4 · 2020: 3 · 2019: 7 · 2018: 8 · 2017: 14 · 2016: 10 · 2015: 14 · 2014: 14 · 2013: 20 · 2012: 15
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Vodafone Foundation
- Engineering and Physical Sciences Research Council
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- telemedicine, diabetes mellitus, self-monitoring of blood glucose, HbA1c, glycemic control, feasibility, acceptability, cost-effectiveness, remote glucose monitoring, diabetes self-management
- MeSH terms
- Clinical Trials as Topic, Diabetes Mellitus, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Patient Acceptance of Health Care, Research Design, Blood Glucose Self-Monitoring, Cohort Studies, Randomized Controlled Trials as Topic, Telemedicine
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