Telephone follow‐up to improve glycaemic control in patients with Type 2 diabetes: systematic review and meta‐analysis of controlled trials

Previous systematic reviews on telemedicine for diabetes often focused on a specific type of telemedicine, a specific outcome, and/or a specific comparator.

“However, these previous reviews have often focused on a specific type of telemedicine, a specific outcome, and/or a specific comparator, which calls for a more comprehensive and inclusive systematic review seeking to compare and synthesize findings for treatment outcomes while adjusting for different study characteristics.”

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].”

Two of the type 2 diabetes reviews were awarded a 3-star weighting.

“Of these, 2 were awarded a 3-star weighting [21,53].”

Ten reviews and one analysis in a mixed review analyzed HbA1c in type 2 diabetes.

“A total of 10 reviews [21,29,30,33,42,43,46,52-54], and 1 analysis in a mixed review [19], analyzed HbA1c in type 2 diabetes.”

Wu et al meta-analyzed 7 RCTs of telephone follow-up and found no significant improvement in HbA1c compared with usual care in the overall pooled analysis.

“Wu et al meta-analyzed 7 RCTs of telephone follow-up and found no significant improvement in HbA1c compared with usual care in the overall pooled analysis [53].”

A prespecified subgroup analysis of more intensive targeted interventions (n=3 RCTs) showed a statistically significant benefit on glycemic control.

“However, a prespecified subgroup analysis of more intensive targeted interventions (n=3 RCTs) showed a statistically significant benefit on glycemic control.”

The highest-weighted evidence showed improvement in HbA1c in type 2 diabetes with interventions remotely monitoring blood glucose and in some more intensive telephone interventions.

“The highest-weighted evidence showed improvement in HbA1c in type 2 diabetes with interventions remotely monitoring blood glucose and in some more intensive telephone interventions [31,38,53].”

Wu et al. identified a significant improvement in HbA1c in a prespecified subgroup analysis of interventions providing intensive professional support.

“they did identify a significant improvement in a prespecified subgroup analysis of interventions providing intensive professional support [53].”

Wu et al. found no overall improvement in HbA1c in a meta-analysis of telephone interventions for type 2 diabetes.

“Wu et al, who analyzed telephone interventions for type 2 diabetes, found no overall improvement in HbA1c in a meta-analysis”

Interventions with multiple components, or more intensive interventions, may be associated with greater benefits.

“Interventions with multiple components, or more intensive interventions, may be associated with greater benefits [30,53,63,68].”

Some evidence suggests that, in the context of type 2 diabetes, more intensive interventions may be associated with greater improvements in glycemic control.

“While some evidence suggests that, in the context of type 2 diabetes, more intensive interventions may be associated with greater improvements in glycemic control, such observations are limited to specific analyses from a small number of included reviews [22,30,53]”

More interactive approaches including case management, motivational interviewing, and more focus on a psychological approach seemed more effective for glycaemic control.

“However, more interactive approaches including case management, motivational interviewing and more focus on a psychological approach seemed more effective.64”

Simple telephone follow-up interventions delivered only a limited benefit in terms of glycaemic control.

“A meta-analysis by Wu et al. 64 in 2010 revealed that simple telephone follow-up interventions delivered only a limited benefit in terms of glycaemic control.”