Telehealth Remote Monitoring Systematic Review: Structured Self-monitoring of Blood Glucose and Impact on A1C
Open accessAbstract
Aims: The aim was to summarize research on telehealth remote patient monitoring interventions that incorporate key elements of structured self-monitoring of blood glucose (SMBG) identified as essential for improving A1C. Methods: A systematic review was conducted using the Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and OVID Medline databases with search terms “Telemedicine” AND “Monitoring, Physiologic” AND “Diabetes Mellitus, Type 2.” Study selection criteria included original randomized clinical trials evaluating the impact of telehealth remote patient monitoring on A1C among adults with type 2 diabetes and incorporated 1 or more essential elements of SMBG identified by the International Diabetes Federation (patient education, provider education, structured SMBG profile, SMBG goals, feedback, data used to modify treatment, interactive communication or shared decision making). Results: Fifteen studies were included, with interventions ranging from 3 to 12 months (mean 8 months) with sample sizes from 30 to 1665. Key SMBG elements were grouped into 3 categories: education, SMBG protocols, and feedback. Research incorporating 5 of the 7 elements consistently achieved significant A1C improvements between study groups. Interventions using more SMBG elements are associated with an improvement in A1C. Studies with the largest A1C decrease incorporated 6 of the 7 elements and computer decision support. Two studies with 5 of the 7 elements and active medication management achieved significant A1C decreases. Conclusion: Telehealth remote patient monitoring interventions in type 2 diabetes have not included all structured monitoring elements recommended by the IDF. Incorporating more elements of structured SMBG is associated with improved A1C.
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For diabetic patients, interventions incorporating elements of structured monitoring of blood glucose identified by the International Diabetes Foundation as essential for improving A1c were associated with comparatively significant improvement in clinical outcomes.
“For diabetic patients, interventions incorporating elements of structured monitoring of blood glucose identified by the International Diabetes Foundation as essential for improving A1c (average blood glucose level over the past 3 months) were associated with comparatively significant improvement in clinical outcomes.”
From Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation (2020) · cites this paper as [96]
The Elements of Structured SMBG section (page unavailable) reports significant between-group A1C decreases in studies incorporating at least five of seven structured-monitoring elements. The review concerns people with type 2 diabetes and establishes improvement in A1C, not significant improvement across clinical outcomes generally or for all diabetic patients. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThree reviews reported that individualised feedback, either through automated algorithms or health care professionals, improved HbA1c control.
“A further 3 reviews reported that individualised feedback, either through automated algorithms or health care professionals, improved HbA1c control [24, 38, 48].”
From Effect of virtual care in type 2 diabetes management – a systematic umbrella review of systematic reviews and meta-analysis (2025) · cites this paper as [38]
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.”
From The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression (2023) · cites this paper as [20]
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.”
Greenwood et al analyzed the components of remotely monitored blood glucose and found that multifaceted interventions carried greater benefit.
“Greenwood et al analyzed the components of remotely monitored blood glucose and found that multifaceted interventions carried greater benefit (discussed under self-management components) [30].”
Of seven 2-star reviews, four were meta-analyses, all of which showed significant reductions in HbA1c compared with controls, although the effect sizes were small.
“Of seven 2-star reviews [29,30,33,42,46,52,54], 4 were meta-analyses, all of which showed significant reductions in HbA1c compared with controls, although the effect sizes were small.”
Supported education and information interventions were particularly effective in the context of diabetes, with 9 larger systematic reviews showing evidence of improvement in HbA1c.
“Supported education and information interventions were particularly effective in the context of diabetes, with 9 larger systematic reviews showing evidence of improvement in HbA1c [27,30,35-37,40,44-46].”
Greenwood et al. concluded that a range of these components need to be incorporated into telehealth interventions for clinically significant improvements in diabetes self-management to be seen.
“The authors concluded that a range of these components need to be incorporated into telehealth interventions for clinically significant improvements in diabetes self-management to be seen.”
Interventions including 5 or more of the 7 components were associated with significant improvement in HbA1c.
“those including 5 or more were associated with significant improvement in HbA1c.”
Greenwood et al. defined 7 separate components of telehealth: patient education, health care provider education, self-monitoring profile, blood glucose goals, use of blood glucose data to modify behavior, feedback to patients, and 2-way interaction.
“They defined 7 separate components of telehealth (patient education, health care provider education, self-monitoring profile, blood glucose goals, use of blood glucose data to modify behavior, feedback to patients, and 2-way interaction).”
Several diabetes reviews included elements of remote clinical review, with some reporting positive outcomes.
“Several diabetes reviews included elements of remote clinical review, with some reporting positive outcomes [27,30,40].”
The only review to explicitly address which components were associated with improved disease outcomes was Greenwood et al., weighted 2 stars.
“The only review to address explicitly the question of which components were associated with improved disease outcomes was Greenwood et al, weighted 2 stars [30].”
No interventions were found incorporating all 7 components.
“No interventions were found incorporating all 7 components”
Greenwood et al. concluded that a range of components (including educational, self-monitoring, goal-driven, and interactive elements) were important in improving glycemic control and emphasized the multifaceted nature of self-management support.
“Greenwood et al concluded that a range of components (including educational, self-monitoring, goal-driven, and interactive elements) were important in improving glycemic control [30] and emphasized the multifaceted nature of self-management support.”
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]”
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- Authors
- Greenwood, D. A., Young, H. M., & Quinn, C. C.
- Affiliations
- University of California, Davis (US)
- University of Maryland, Baltimore (US)
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2014-02-21
- Volume
- 8
- Issue
- 2
- Pages
- 378-389
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC4455426
- OpenAlex
- W2132057588
- Semantic Scholar
- 8497088d7d47d74e0e7c4aa3680d68cca250cc60
- Cited by
- 96
- References
- 57
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 8 · 2023: 9 · 2022: 7 · 2021: 4 · 2020: 14 · 2019: 12 · 2018: 9 · 2017: 7 · 2016: 10 · 2015: 5 · 2014: 1
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- LifeScan
- Maryland Industrial Partnerships
- A. James Clark School of Engineering
- Maryland Technology Enterprise Institute
- 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, remote patient monitoring, type 2 diabetes, HbA1c, patient education, computer decision support, medication management, shared decision-making
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Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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