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Cited by 19Telemedicine and Telehealth ImplementationDiabetes Management and EducationDiabetes Management and Research

Effect of virtual care in type 2 diabetes management – a systematic umbrella review of systematic reviews and meta-analysis

Open access
Ravi, Sumathy, Meyerowitz-Katz, Gideon, Yung, Cassia, Ayre, Julie, McCaffery, Kirsten, Maberly, Glen, Bonner, Carissa·2025·BMC Health Services Research
DOI 10.1186/s12913-025-12496-0PMC PMC11884068
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Abstract

Background: Diabetes is an increasingly prevalent and costly chronic disease worldwide, and a large cause of unnecessary disease burden. To address the growing burden of diabetes, care models should support management of diabetes in primary care to reduce reliance on overstretched hospital-based specialists services. Virtual care presents an opportunity to provide diabetes care remotely, potentially enhancing the accessibility and efficiency of healthcare services. This review aimed to identify existing evidence on the effectiveness of virtual care on diabetes management, and the extent to which video components are included in the evidence base. Methods: The protocol was registered in PROSPERO (CRD42022366125). Systematic search of the databases PubMed, Embase, Medline, Scopus, CINAHL and Cochrane CENTRAL, were conducted for studies on telemedicine, telehealth, or virtual interventions for type 2 diabetes management published between January 2011 to March 2022. The primary outcome was HbA1c, and secondary outcomes were blood glucose control, Body Mass Index (BMI), taking the prescribed medications, and self-management behaviour. The results were reported following the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist. Quality of each review was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Results: From 10,708 articles, 63 underwent full-text review. Thirty systematic reviews were included. Overall quality of the included reviews was high. Among the 30 systematic reviews, there was significant overlap of the primary studies, with 48% of them appearing in multiple reviews. Of the 30 reviews, 28 reported that virtual care improved HbA1c compared to usual care. Meta-analysis of 16 reviews revealed a mean difference of -0.37% (-0.41% to -0.32%), I 2 of 77.1%. Significant non-clinical impacts were noted for BMI and secondary outcomes. Most reviews (25/30) included some studies with video components, however these studies did not disaggregate the impact of video from other aspects of complex interventions such as web-based and telephone support. Conclusions: This umbrella review strengthens the evidence that virtual care significantly improves clinical outcomes in people with type 2 diabetes, primarily affecting HbA1c. Fewer studies addressed other health outcomes such as BMI and taking medications. Effectiveness of virtual care varies by demographic and clinical characteristics, emphasising the need to tailor virtual care interventions to maximise impact. Future research could directly compare and identify the most effective virtual care strategies for different populations, including those with lower digital literacy.

AI snapshot

Written from the paper’s full text.

TL;DR

This umbrella review of 30 systematic reviews found that virtual care significantly improves HbA1c in type 2 diabetes, with a pooled mean difference of −0.37% versus usual care. Most reviews included some video component, but few isolated the effect of video from other virtual care elements.

Key findings

  • Of 30 systematic reviews, 28 reported that virtual care improved HbA1c compared with usual care; meta-analysis of 16 reviews found a mean difference of −0.37% (95% CI −0.41% to −0.32%), with I² = 77.1%.
  • In a sensitivity analysis restricted to 12 reviews with type 2 diabetes-specific HbA1c measures, the mean reduction was −0.41% (95% CI −0.49% to −0.34%; I² = 80.8%).
  • BMI showed no statistically significant difference between virtual care and usual care in meta-analysis of 4 reviews: reduction of 0.13 (95% CI −0.28 to 0.03; I² = 25.5%).
  • Most reviews (25/30) included studies with video components, but these studies did not disaggregate the impact of video from other aspects of complex interventions such as web-based and telephone support.

Methods

  • Systematic umbrella review of systematic reviews and meta-analyses, registered in PROSPERO (CRD42022366125), reported per PRISMA; searches covered PubMed, Embase, Medline, Scopus, CINAHL, and Cochrane CENTRAL for studies published January 2011 to March 2022.
  • Included 30 systematic reviews of virtual care interventions for adults with type 2 diabetes; primary outcome was HbA1c, with secondary outcomes including blood glucose control, BMI, medication adherence, and self-management behaviour.
  • Quality was appraised with the Joanna Briggs Institute Critical Appraisal Checklist; meta-analytic estimates used a random-effects inverse-variance model in Stata 15, with heterogeneity assessed by I².

Limitations

  • The authors state that relevant studies may have been missed because MeSH terms were not used, given the difficulty of capturing complex video-component interventions with established search terms.
  • The authors report significant overlap among primary studies in the included meta-analyses: 404 of 847 studies were at least duplicates (47.7%), which may affect meta-analysis estimates; they did not recalculate estimates excluding duplicates because it was not feasible.
  • The authors note possible reporting bias within included reviews and that some included studies did not provide disaggregated outcomes for type 2 diabetes, potentially obscuring true effects for that population.
  • Evident from the text: heterogeneity was high (I² = 77.1% overall; 80.8% in the type 2 diabetes sensitivity analysis), and most video-component studies did not isolate the effect of video.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12913-025-12496-0

Cites

52 of 52 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

44 of 78 cited sources checked · 19 supported · 4 flagged · accuracy not yet measured

  • Findingcitation

    Two reviews reported a reduction in fasting blood glucose with virtual care.

    “out of which 2 reviews reported reduction in fasting blood glucose [32, 46]”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [32] Eberle C, Stichling S. Effect of Telemetric Interventions on Glycated Hemoglobin A1c and Management of Type 2 Diabetes Mellitus: Systematic Meta-Review. J Med Internet Res. 2021;23(2):e23252. https://doi.org/10.2196/23252. source
    • cites [46] McDaniel CC, Kavookjian J, Whitley HP. Telehealth delivery of motivational interviewing for diabetes management: A systematic review of randomized controlled trials. Patient Educ Couns. 2021;105(4):805–20. https://doi.org/10.1016/j.pec.2021.07.036. source

      The Results > Outcomes section states that fasting blood glucose was not affected by MI-based telehealth. The review reports reductions in A1C, but not in fasting blood glucose. (LLM, conf=0.91)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Findingown data

    All seven reviews reported a reduction in blood pressure with virtual care.

    “all 7 reviews [22, 27, 32, 35, 37, 44, 46] reported reduction in blood pressure.”
    Quote in the paperSubstantial claim6 of 7 sources checked
    • cites [22] Kaveh MH, Faradonbeh MR, Kaveh S. Telehealth impact on biomedical, psychosocial, and behavioural outcomes in patients with diabetes older than 50 years: A systematic synthesis without meta-analysis. J Telemed Telecare. 2024;30(2):285–304. https://doi.org/10.1177/1357633X211052222. source
    • cites [27] Hossain MM, Tasnim S, Sharma R, Sultana A, Shaik AF, Faizah F, et al. Digital interventions for people living with non-communicable diseases in India: A systematic review of intervention studies and recommendations for future research and development. Digit Health. 2019;5:2055207619896153. https://doi.org/10.1177/2055207619896153. source
    • cites [32] Eberle C, Stichling S. Effect of Telemetric Interventions on Glycated Hemoglobin A1c and Management of Type 2 Diabetes Mellitus: Systematic Meta-Review. J Med Internet Res. 2021;23(2):e23252. https://doi.org/10.2196/23252. source
    • cites [35] Wu C, Wu Z, Yang L, Zhu W, Zhang M, Zhu Q, et al. Evaluation of the clinical outcomes of telehealth for managing diabetes: A PRISMA-compliant meta-analysis. Medicine (Baltimore). 2018;97(43):e12962. https://doi.org/10.1097/MD.0000000000012962. source
    • cites [37] Marcolino MS, Maia JX, Alkmim MB, Boersma E, Ribeiro AL. Telemedicine application in the care of diabetes patients: systematic review and meta-analysis. PLoS ONE. 2013;8(11):e79246. https://doi.org/10.1371/journal.pone.0079246. source

      In Results of the Review, under 'Association of intervention on the primary and secondary outcomes,' the paper reports no significant effect on either systolic or diastolic blood pressure compared with usual care. Although the point estimates were negative, the paper describes its finding as no blood-pressure effect, contrary to the unqualified claim that this review reported a reduction. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [44] 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):170–97. https://doi.org/10.4239/wjd.v12.i2.170. source
    • cites [46] McDaniel CC, Kavookjian J, Whitley HP. Telehealth delivery of motivational interviewing for diabetes management: A systematic review of randomized controlled trials. Patient Educ Couns. 2021;105(4):805–20. https://doi.org/10.1016/j.pec.2021.07.036. source
  • Findingcitation

    Three reviews reported that text-messaging or SMS feedback was equally effective in improving HbA1c compared to a teleconference or telephone appointment with healthcare professionals.

    “3 reviews [28, 31, 43] reported that interventions as simple as text-messaging or SMS feedback were equally effective in improving HbA1c, compared to a teleconference or telephone appointment with healthcare professionals.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [28] Su D, McBride C, Zhou J, Kelley MS. Does nutritional counseling in telemedicine improve treatment outcomes for diabetes? A systematic review and meta-analysis of results from 92 studies. J Telemed Telecare. 2016;22(6):333–47. https://doi.org/10.1177/1357633X15608297. source
    • cites [31] Faruque LI, Wiebe N, Ehteshami-Afshar A, Liu Y, Dianati-Maleki N, Hemmelgarn BR, et al. Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials. CMAJ. 2017;189(9):E341–64. https://doi.org/10.1503/cmaj.150885. source

      The Meta-regression analysis reports that provider-to-patient SMS text messaging was associated with a significantly greater HbA1c benefit than telephone-based systems, not an equal benefit. The paper does not establish a separate comparison with teleconference appointments. (LLM, conf=0.89)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [43] Correia JC, Meraj H, Teoh SH, Waqas A, Ahmad M, Lapao LV, et al. Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ. 2021;99(3):209–19. https://doi.org/10.2471/BLT.19.250068. source

      In Results > Meta-analysis (Table 2; page not provided), SMS, telephone and video-conference interventions have HbA1c estimates with no statistically significant between-group difference (P = 0.66). That supports a comparison, but it does not establish equal effectiveness; the SMS estimate’s 95% confidence interval includes no improvement. This source is one review, not evidence that three reviews reached that conclusion. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Findingcitation

    Three reviews reported that video conferencing was effective in improving HbA1c levels over periods ranging from 3 to 12 months.

    “Three reviews [32, 34, 44] reported that video conferencing was effective in improving HbA1c levels over periods ranging from 3–12 months.”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [32] Eberle C, Stichling S. Effect of Telemetric Interventions on Glycated Hemoglobin A1c and Management of Type 2 Diabetes Mellitus: Systematic Meta-Review. J Med Internet Res. 2021;23(2):e23252. https://doi.org/10.2196/23252. source
    • cites [34] McLendon SF. Interactive Video Telehealth Models to Improve Access to Diabetes Specialty Care and Education in the Rural Setting: A Systematic Review. Diabetes Spectr. 2017;30(2):124–36. https://doi.org/10.2337/ds16-0004. source
    • cites [44] 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):170–97. https://doi.org/10.4239/wjd.v12.i2.170. source

      The Results (page unavailable) report a significant HbA1c reduction for videoconference interventions. The paper analyzes intervention duration separately, however, and does not establish that the videoconference finding applies specifically across 3–12 months; its Data extraction table includes a five-year intervention with videoconferencing. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Findingcitation

    All three reviews of teleconsultation interventions versus usual care reported significant effects on lowering HbA1c levels.

    “Of the 3 reviews that analysed the effect of teleconsultation interventions vs usual care, all reported significant effects on lowering HbA1c levels [20, 21, 29].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [20] Lee SWH, Chan CKY, Chua SS, Chaiyakunapruk N. Comparative effectiveness of telemedicine strategies on type 2 diabetes management: A systematic review and network meta-analysis. Sci Rep. 2017;7(1):12680. https://doi.org/10.1038/s41598-017-12987-z. source
    • cites [21] Tchero H, Kangambega P, Briatte C, Brunet-Houdard S, Retali GR, Rusch E. Clinical Effectiveness of Telemedicine in Diabetes Mellitus: A Meta-Analysis of 42 Randomized Controlled Trials. Telemed J E Health. 2019;25(7):569–83. https://doi.org/10.1089/tmj.2018.0128. source
    • cites [29] Su D, Zhou J, Kelley MS, Michaud TL, Siahpush M, Kim J, et al. Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials. Diabetes Res Clin Pract. 2016;116:136–48. https://doi.org/10.1016/j.diabres.2016.04.019. source
  • May combine two claims. 41
  • Classified as probably not a substantial claim. 30
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    One recent review analysed the effect of telemedicine across all health conditions, with very few studies focusing on diabetes.

    “One recent review [51] analysed the effect of telemedicine across all health conditions, with very few studies focusing on diabetes.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [51] Goharinejad S, Hajesmaeel-Gohari S, Jannati N, Goharinejad S, Bahaadinbeigy K. Review of Systematic Reviews in the Field of Telemedicine. Med J Islam Repub Iran. 2021;35:184. https://doi.org/10.47176/mjiri.35.184. source

      The Results (Telemedicine Specialty) support that the review covered multiple telemedicine specialties, but contradict the claim that very few reviews focused on diabetes: tele-diabetes care was the third-largest category, with 18 of 191 reviews (9.4%). The Conclusion also identifies tele-diabetes as one of the areas studied further. (LLM, conf=0.85)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    With increased and widespread access to internet and smart devices, recent advances in diabetes technology, and rapid changes during the COVID pandemic, virtual care has become more feasible and scalable than ever before.

    “With increased and widespread access to internet and smart devices, recent advances in diabetes technology, and rapid changes during the COVID pandemic, virtual care has become more feasible and scalable than ever before [8].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare. 2020;26(5):309–13. https://doi.org/10.1177/1357633X20916567. source

      The sections on previous emergency use and reimbursement describe telehealth applications during COVID-19 and changes that expanded access to telehealth services. The paper also discusses infrastructure that could be scaled up, but does not attribute greater feasibility to widespread internet or smart-device access or to advances in diabetes technology. It does not establish the comparison “more feasible and scalable than ever before.” No page numbers were provided in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The systematic review of reviews and meta-analysis was conducted in accordance with the PRISMA 2020 statement.

    “This systematic review of reviews and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 statement [12].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71. source

      The Abstract identifies PRISMA 2020 as a reporting guideline for systematic reviews, and the Scope of the guideline says it applies to reviews with meta-analysis. But the Scope explicitly says PRISMA 2020 is not intended to guide systematic review conduct. The source therefore supports citing it as a reporting standard, not as a standard for how the review was conducted. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The quality of diabetes care is compromised by time constraints and fragmented care.

    “The quality of care is also compromised by time constraints and fragmented care [4].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] Manski-Nankervis JA, Furler J, Blackberry I, Young D, O’Neal D, Patterson E. Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory. BMC Fam Pract. 2014;15(1):20. https://doi.org/10.1186/1471-2296-15-20. source

      The Results (Uncertain competency and capacity; page unavailable) identify inadequate time for practice nurses as a safety concern in insulin initiation. The Results (Varying relationships and communication; page unavailable) describe poor communication across providers, and the Conclusion says barriers to coordination may harm patients. These findings support the concern, but the paper focuses on insulin initiation in general practice rather than establishing that time constraints and fragmented care compromise diabetes care generally. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Previous research suggests that components of virtual care interventions lead to positive outcomes for people with type 2 diabetes such as improved blood glucose control and knowledge to manage their diabetes.

    “Previous research suggests that components of virtual care interventions lead to positive outcomes for people with type 2 diabetes such as improved blood glucose control and knowledge to manage their diabetes [9, 10].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [9] Esmatjes E, Jansa M, Roca D, Perez-Ferre N, del Valle L, Martinez-Hervas S, et al. The efficiency of telemedicine to optimize metabolic control in patients with type 1 diabetes mellitus: Telemed study. Diabetes Technol Ther. 2014;16(7):435–41. https://doi.org/10.1089/dia.2013.0313. source

      The Clinical evolution section (page not provided) reports improved HbA1c and diabetes-knowledge scores in the telemedicine group, but the participants had type 1 diabetes, not type 2. Both the telemedicine and face-to-face groups improved, so the study does not establish that a particular virtual-care component caused the gains. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites [10] Gonzalez-Molero I, Dominguez-Lopez M, Guerrero M, Carreira M, Caballero F, Rubio-Martin E, et al. Use of telemedicine in subjects with type 1 diabetes equipped with an insulin pump and real-time continuous glucose monitoring. J Telemed Telecare. 2012;18(6):328–32. https://doi.org/10.1258/jtt.2012.120103. source

  • May combine two claims.

    Findingown data

    Only one study included in the BMI meta-analysis reported the BMI measure for type 2 diabetes, and all other three reviews included combined results for mixed type of diabetes.

    “Only one study [44] included in this analysis reported the BMI measure for type 2 diabetes and all other three reviews included combined results for mixed type of diabetes.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [44] 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):170–97. https://doi.org/10.4239/wjd.v12.i2.170. source

  • May combine two claims.

    Findingown data

    The findings suggest that virtual care had a greater impact on older people with type 2 diabetes over 50 years of age in managing their diabetes effectively, which contradicts another umbrella review that reported virtual care had a greater effect on younger people with type 2 diabetes aged 41 to 50 years.

    “Our findings from this review suggest that virtual care had a greater impact on older people with type 2 diabetes over 50 years of age in managing their diabetes effectively, which contradicts another umbrella review that reported virtual care had a greater effect on younger people with type 2 diabetes aged 41 to 50 years [53].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [53] Timpel P, Oswald S, Schwarz PEH, Harst L. Mapping the Evidence on the Effectiveness of Telemedicine Interventions in Diabetes, Dyslipidemia, and Hypertension: An Umbrella Review of Systematic Reviews and Meta-Analyses. J Med Internet Res. 2020;22(3):e16791. https://doi.org/10.2196/16791. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One review concluded that interactive video telehealth technologies might be effective in enhancing access to quality care, patient empowerment and self-care management.

    “One review concluded that interactive video telehealth technologies might be effective in enhancing access to quality care, contribute to patient empowerment and self-care management [34].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [34] McLendon SF. Interactive Video Telehealth Models to Improve Access to Diabetes Specialty Care and Education in the Rural Setting: A Systematic Review. Diabetes Spectr. 2017;30(2):124–36. https://doi.org/10.2337/ds16-0004. source

  • May combine two claims.

    Findingcitation

    Interventions between 6 and 12 months were described as more effective because the benefits of virtual care may occur in the first few months or become more difficult to implement robustly and keep people with type 2 diabetes engaged over the longer term.

    “Interventions between 6 and 12 month were described as more effective because the benefits of virtual care may occur in the first few months or become more difficult to implement robustly and keep people with type 2 diabetes engaged over the longer term [37].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [37] Marcolino MS, Maia JX, Alkmim MB, Boersma E, Ribeiro AL. Telemedicine application in the care of diabetes patients: systematic review and meta-analysis. PLoS ONE. 2013;8(11):e79246. https://doi.org/10.1371/journal.pone.0079246. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    This is consistent with previous research on telehealth remote monitoring using Self-Monitoring of Blood Glucose transmission devices.

    “This is consistent with previous research on telehealth remote monitoring using Self-Monitoring of Blood Glucose (SMBG) transmission devices [52, 53].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [52] Lee PA, Greenfield G, Pappas Y. The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis of systematic reviews of randomised controlled trials. BMC Health Serv Res. 2018;18(1):495. https://doi.org/10.1186/s12913-018-3274-8. source
    • cites [53] Timpel P, Oswald S, Schwarz PEH, Harst L. Mapping the Evidence on the Effectiveness of Telemedicine Interventions in Diabetes, Dyslipidemia, and Hypertension: An Umbrella Review of Systematic Reviews and Meta-Analyses. J Med Internet Res. 2020;22(3):e16791. https://doi.org/10.2196/16791. source

      The Discussion (Principal Findings; page not available) reports evidence that telemonitoring combined with tele-case management reduced HbA1c in patients with type 2 diabetes. It does not identify Self-Monitoring of Blood Glucose transmission devices as the technology used, so it supports the broader remote-monitoring point but not that specific device description. (LLM, conf=0.81)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    Messages generated using automated algorithms may offer a more feasible and less expensive solution.

    “Messages generated using automated algorithms may offer a more feasible and less expensive solution [31].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] Faruque LI, Wiebe N, Ehteshami-Afshar A, Liu Y, Dianati-Maleki N, Hemmelgarn BR, et al. Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials. CMAJ. 2017;189(9):E341–64. https://doi.org/10.1503/cmaj.150885. source

  • May combine two claims.

    Findingown data

    Four reviews were included for meta-analyses of BMI and there was no statistically significant difference in BMI between virtual care interventions and usual care, with a reduction of 0.13 (95% CI: −0.28 to 0.03; I2 = 25.5%).

    “Four reviews were included for meta-analyses and there was no statistically significant difference of BMI between virtual care interventions and usual care, with only a reduction of 0.13 [95% CI: −0.28 to 0.03; I2 = 25.5%] (Fig. 4).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The search strategy identified 30 systematic reviews, of which 18 included a meta-analysis, and one included a network meta-analysis.

    “The search strategy identified 30 systematic reviews, of which 18 included a meta-analysis, and one included a network meta-analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Included systematic reviews were published between 2012 and 2022, with 24 (80%) reporting fewer than 50 studies, 3 between 50-100, and 3 more than 100 studies.

    “Included systematic reviews were published between 2012 and 2022, with the majority (n = 24; 80%) reporting fewer than 50 studies, 3 articles between 50–100 and 3 articles with more than 100 studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of the six databases searched, 10,708 citations were identified and transferred to Covidence, which removed 4,629 duplicates.

    “Of the six databases searched, a total of 10,708 citations were identified and transferred to Covidence, which removed 4,629 duplicates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Exclusion of Michaud 2021 in sensitivity analysis did not significantly alter the results or heterogeneity, with MD −0.38% (95% CI: −0.44 to 0.32, I2 = 71.8).

    “Exclusion of this review did not significantly alter the results or heterogeneity [MD −0.38% (95% CI: −0.44 to 0.32, I2 = 71.8)].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One review, Michaud 2021, contributed an unexpectedly high weighting on the initial analysis because of its narrow CI bounds.

    “One review, Michaud 2021 [24], contributed an unexpectedly high weighting on the initial analysis because of its narrow CI bounds.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Michaud TL, Ern J, Scoggins D, Su D. Assessing the Impact of Telemonitoring-Facilitated Lifestyle Modifications on Diabetes Outcomes: A Systematic Review and Meta-Analysis. Telemed J E Health. 2021;27(2):124–36. https://doi.org/10.1089/tmj.2019.0319. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most reviews (25/30) included some studies with video components.

    “Most reviews (25/30) included some studies with video components”
    • Also stated in: § Characteristics of the included reviews (Table 1) · plain
      “Twenty five out of 30 reviews included a minority of studies with video components, such as video consultation, video conferencing or video messages as part of the virtual care interventions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The full text review resulted in 63 studies that included 30 systematic reviews, 3 review of reviews, 23 RCTs, and 7 qualitative studies.

    “The full text review resulted in a total of 63 studies that included 30 systematic reviews, 3 review of reviews, 23 RCTs, and 7 qualitative studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Meta-analysis of 16 reviews revealed a mean difference in HbA1c of -0.37% (95% CI -0.41% to -0.32%), with I2 of 77.1%.

    “Meta-analysis of 16 reviews revealed a mean difference of -0.37% (-0.41% to -0.32%), I2 of 77.1%.”
    • Also stated in: § Clinical outcomes · plain
      “The mean reduction in HbA1c was 0.37% (95% CI: −0.41% to −0.32%).”
    • Also stated in: § Clinical outcomes · plain
      “Heterogeneity was high, with an I2 of 77.1%”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    After title and abstract screening, 85 studies were obtained for full text assessment.

    “After title and abstract screening, a total of 85 studies were obtained for full text assessment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Three reviews included diabetes and other conditions but did not specify the type of diabetes.

    “Three reviews included diabetes and other conditions but did not specify the type of diabetes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The reviews covered 68 countries in 6 continents.

    “The reviews covered 68 countries in 6 continents.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Eight out of thirty reviews described the effect of virtual care on BMI as a secondary outcome measure.

    “Eight out of thirty reviews described the effect of virtual care on BMI as a secondary outcome measure.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The number of participants ranged from 10 to 23,648 in individual studies.

    “The number of participants ranged from 10 to 23,648 in individual studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Four out of 14 reviews with mixed populations reported findings separately for people with type 2 diabetes.

    “Four out of 14 reviews reported findings separately for people with type 2 diabetes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of the 30 reviews, 13 focused exclusively on populations with type 2 diabetes, while 14 included mixed populations consisting of type 2 and/or type 1, gestational diabetes, and pre-diabetes.

    “Of the 30 reviews, 13 focused exclusively on populations with type 2 diabetes, while 14 included mixed populations, consisting of individuals with type 2 diabetes, and/or type 1, gestational diabetes, and pre-diabetes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 85 studies, 22 were removed.

    “Of these studies, a further 22 studies were removed (see Fig. 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among the 30 systematic reviews, there was significant overlap of the primary studies, with 48% of them appearing in multiple reviews.

    “Among the 30 systematic reviews, there was significant overlap of the primary studies, with 48% of them appearing in multiple reviews.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One review suggested that any evaluation less than 3 months would not be sufficient because of the time required to educate people with type 2 diabetes with virtual care systems or devices.

    “One review suggested that any evaluation less than 3 months would not be sufficient because of the time required to educate people with type 2 diabetes with virtual care systems or devices [30].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Hu Y, Wen X, Wang F, Yang D, Liu S, Li P, et al. Effect of telemedicine intervention on hypoglycaemia in diabetes patients: A systematic review and meta-analysis of randomised controlled trials. J Telemed Telecare. 2019;25(7):402–13. https://doi.org/10.1177/1357633X18776823. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One review reported that virtual care was effective in enhancing patient-provider interactions.

    “one review [26] reported virtual care was effective in enhancing patient-provider interactions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Marsh Z, Nguyen Y, Teegala Y, Cotter VT. Diabetes management among underserved older adults through telemedicine and community health workers. J Am Assoc Nurse Pract. 2021;34(1):26–31. https://doi.org/10.1097/JXX.0000000000000595. source

  • May combine two claims.

    Findingown data

    Virtual care showed mixed effects on BMI, fasting blood glucose, lipids, blood pressure, and body weight, but these were not statistically or clinically significant.

    “Consistent with previous findings, virtual care showed mixed effects on BMI, fasting blood glucose, lipids, blood pressure, and body weight, but these were not statistically or clinically significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Results of the study indicated that virtual care improved behavioural outcomes, including improvements in treatment and medication adherence, self-efficacy, and quality of life.

    “Results of our study also indicated that virtual care improved behavioural outcomes, including improvements in treatment and medication adherence, self-efficacy, and quality of life.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The diverse virtual care interventions included in the reviews are sufficiently comparable to be synthesised into an overall assessment of virtual care effectiveness.

  • May combine two claims.

    Findingown data

    Four reviews showed reduction in body weight or improved weight loss with virtual care, but not statistically significant.

    “four reviews showed reduction in body weight or improved weight loss, but not statistically significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Virtual care interventions had a greater effect among adults aged 50 years or older, with better treatment outcomes compared to younger adults, as reported in five reviews.

    “Virtual care interventions were found to have greater effect among adults who were 50 years or older, with better treatment outcomes compared to younger adults reported in 5 reviews [21, 22, 26, 29, 36].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [21] Tchero H, Kangambega P, Briatte C, Brunet-Houdard S, Retali GR, Rusch E. Clinical Effectiveness of Telemedicine in Diabetes Mellitus: A Meta-Analysis of 42 Randomized Controlled Trials. Telemed J E Health. 2019;25(7):569–83. https://doi.org/10.1089/tmj.2018.0128. source
    • cites [22] Kaveh MH, Faradonbeh MR, Kaveh S. Telehealth impact on biomedical, psychosocial, and behavioural outcomes in patients with diabetes older than 50 years: A systematic synthesis without meta-analysis. J Telemed Telecare. 2024;30(2):285–304. https://doi.org/10.1177/1357633X211052222. source
    • cites [26] Marsh Z, Nguyen Y, Teegala Y, Cotter VT. Diabetes management among underserved older adults through telemedicine and community health workers. J Am Assoc Nurse Pract. 2021;34(1):26–31. https://doi.org/10.1097/JXX.0000000000000595. source

  • May combine two claims.

    Findingnone given

    The study includes 15 systematic reviews that were not included in 3 previous umbrella reviews, including 11 systematic reviews published in the emergency phase of the COVID-19 pandemic.

    “Our study includes 15 systematic reviews that were not included in 3 previous umbrella reviews, including 11 systematic reviews published in the emergency phase of the COVID-19 pandemic, which accelerated virtual care due to lockdowns.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two investigators independently conducted data extraction from the final selected studies and disagreements were resolved through discussion.

    “Two investigators (SR and CY) then independently conducted data extraction from the final selected studies using the agreed-upon form. The extracted data were compared and any disagreements resolved through discussion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two independent investigators screened titles and abstracts and resolved disagreements.

    “Two independent investigators (SR and GMK) screened the titles and abstracts on Covidence according to the criteria described above to determine the eligibility for inclusion and compared the lists to resolve any disagreements.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Consistent engagement between people with type 2 diabetes and healthcare professionals for ongoing support for diabetes management and self-care helps to prevent diabetes related complications and improves quality of life.

    “Such consistent engagement between people with type 2 diabetes and healthcare professionals for ongoing support for diabetes management and self-care helps to prevent diabetes related complications and improves quality of life [2].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] American Diabetes Association Professional Practice C. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S111-S25. https://doi.org/10.2337/dc24-S006.1/16/2024. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two independent investigators reviewed full texts to establish a final list of studies, with discrepancies resolved by consulting third and fourth investigators.

    “The two investigators (SR and GMK) then independently reviewed the full text of selected studies to establish a final list of studies. Any discrepancies were resolved by consulting with the third and fourth investigators (CB and JA).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    This umbrella review strengthens the evidence that virtual care significantly improves clinical outcomes in people with type 2 diabetes, primarily affecting HbA1c.

    “This umbrella review strengthens the evidence that virtual care significantly improves clinical outcomes in people with type 2 diabetes, primarily affecting HbA1c.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The data extraction form was piloted using two review articles and discussed to reach agreement.

    “The extraction form was piloted by SR using two review articles. The pilot process and extracted information were discussed with CB and JA to reach an agreement on the form.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Virtual care has advantages such as easier access, minimal wait times, no travel to clinics, and therefore less expensive diabetes care.

    “Though face-to-face care will always have a role, virtual care has several advantages such as easier access, minimal wait times and no travel to clinics, therefore less expensive diabetes care [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Iyengar V, Wolf A, Brown A, Close K. Challenges in Diabetes Care: Can Digital Health Help Address Them? Clin Diabetes. 2016;34(3):133–41. https://doi.org/10.2337/diaclin.34.3.133.1/9/2024. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Visiting a health care team can be costly and time-consuming for people with type 2 diabetes, and most people with type 2 diabetes do not see their health professionals enough.

    “Visiting a health care team can be costly and time-consuming for people with type 2 diabetes, with evidence suggesting most people with type 2 diabetes do not see their health professionals enough [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract. 2011;93(1):1–9. https://doi.org/10.1016/j.diabres.2011.02.002. source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Methodological quality was assessed independently by two reviewers using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Synthesis.

    “Assessment of the methodological quality was completed by two reviewers (SR and GMK) independently on all selected articles included in the systematic review using the Joanna Briggs Institute’s (JBI) Critical Appraisal Checklist for Systematic Reviews and Research Synthesis [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015;13(3):132–40. https://doi.org/10.1097/XEB.0000000000000055. source

  • May combine two claims.

    Premisecitation

    HbA1c is recognised as a valuable indicator of treatment effectiveness in people with type 2 diabetes because it reflects average glycemia over several months and is strongly correlated with diabetes complications.

    “HbA1c is recognised as a valuable indicator of treatment effectiveness in people with type 2 diabetes [2], because it reflects average glycemia over several months and is strongly correlated with diabetes complications [2, 18, 19].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [2] American Diabetes Association Professional Practice C. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S111-S25. https://doi.org/10.2337/dc24-S006.1/16/2024. source

      Not checked in the free run.

    • cites [18] Nathan DM, Genuth S, Lachin J, Cleary P, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86. https://doi.org/10.1056/NEJM199309303291401. source
    • cites [19] Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405–12. https://doi.org/10.1136/bmj.321.7258.405. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The protocol was registered with PROSPERO (CRD42022366125) in October 2022.

    “The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42022366125) in October 2022 [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Ravi S, Meyerowitz-Katz G, Ayre J, McCaffery K, Maberly G, Bonner C. Virtual Care for type 2 diabetes: definitions, implementation and effectiveness compared to usual care. PROSPERO 2022 CRD42022366125. 2022. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022366125.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    It is possible that reporting bias within the included reviews could have impacted which studies were included, which may have also biased the findings.

    “In addition, it is possible that reporting bias within the included reviews could have impacted which studies were included, which may have also biased our findings.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Reporting bias within the included reviews did not substantially bias the findings.

  • May combine two claims.

    Interpretationown data

    The 47.7% overlap affects the accuracy of the meta-analysis estimates, as it represents a significant portion of the research that would have been duplicated in the meta-analysis.

    “This 47.7% overlap affects the accuracy of our meta-analysis estimates, as it represents a significant portion of the research would have been duplicated in our meta-analysis.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 47.7% overlap among primary studies does not invalidate the meta-analysis estimates.

  • May combine two claims.

    Interpretationown data

    The current study shows that whilst virtual care may not be universally beneficial for health outcomes, it does seem to play a specific and significant role in the context of diabetes.

    “Our current study shows that whilst virtual care may not be universally beneficial for health outcomes, it does seem to play a specific and significant role in the context of diabetes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    For people with type 2 diabetes, reducing the mean HbA1c level by 1% would be related to a 21% reduction in diabetes-related death and a 37% reduction in microvascular complications such as neuropathy, retinopathy, and blindness.

    “For people with type 2 diabetes, reducing the mean HbA1c level by 1% would be related to a 21% reduction in diabetes-related death and a 37% reduction in microvascular complications, such as neuropathy, retinopathy, and blindness [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405–12. https://doi.org/10.1136/bmj.321.7258.405. source

  • May combine two claims.

    Interpretationcitation

    Virtual care may be particularly effective for older adults aged 50 and above and for people with type 2 diabetes with higher baseline HbA1c levels.

    “Virtual care may be particularly effective for older adults, especially those aged 50 and above [23, 29], and for people with type 2 diabetes with higher baseline HbA1c levels [33].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [23] Cassimatis M, Kavanagh DJ. Effects of type 2 diabetes behavioural telehealth interventions on glycaemic control and adherence: a systematic review. J Telemed Telecare. 2012;18(8):447–50. https://doi.org/10.1258/jtt.2012.gth105. source
    • cites [29] Su D, Zhou J, Kelley MS, Michaud TL, Siahpush M, Kim J, et al. Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials. Diabetes Res Clin Pract. 2016;116:136–48. https://doi.org/10.1016/j.diabres.2016.04.019. source
    • cites [33] Huang Z, Tao H, Meng Q, Jing L. Management of endocrine disease. Effects of telecare intervention on glycemic control in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Eur J Endocrinol. 2015;172(3):R93-101. https://doi.org/10.1530/EJE-14-0441. source

  • May combine two claims.

    Study design and conductreasoning

    The overlap number was included as a potential limitation that may have impacted the estimates, but it was not mitigated in the analysis.

    “Therefore, we included this overlap number as a potential limitation that may have impacted the estimates, but we have not mitigated it as such in our analysis.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 47.7% overlap among primary studies does not invalidate the meta-analysis estimates.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    In this review robust methods were used to generate high-quality evidence on the effects of virtual care in diabetes management.

    “In this review robust methods were used to generate high-quality evidence on the effects of virtual care in diabetes management.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    MeSH terms were not used to avoid missing relevant articles because complex interventions with video components did not align well with established search terms.

    “As we aimed to capture complex interventions with video components, which did not align well with established search terms, MeSH terms were, therefore not used to avoid missing relevant articles.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Interpretationreasoning

    Evidence from systematic reviews and meta-analyses demonstrates the effectiveness of virtual care interventions for clinical outcomes, with mixed evidence for behavioural outcomes.

    “Evidence from systematic reviews and meta-analyses demonstrates the effectiveness of virtual care interventions for clinical outcomes, with mixed evidence for behavioural outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The effectiveness of virtual care interventions varies based on demographic and clinical characteristics, highlighting the importance of customising these interventions to maximise their impact.

    “The effectiveness of virtual care interventions varies based on demographic and clinical characteristics, highlighting the importance of customising these interventions to maximise their impact.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The use of SMS text messaging could be an effective and cost-efficient way to communicate and motivate people with type 2 diabetes, potentially leading to positive outcomes.

    “The use of SMS text messaging could be an effective and cost-efficient way to communicate and motivate people with type 2 diabetes, potentially leading to positive outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    This limitation applies across the literature and is a fundamental problem with meta-syntheses of this type.

    “This limitation applies across the literature and is a fundamental problem with meta-syntheses of this type.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    A comprehensive and piloted search strategy was developed using a broad set of keywords, but some relevant studies may have been missed.

    “Although a comprehensive and piloted search strategy was developed using the broad set of keywords, it is possible that some relevant studies would have been missed.”
    Quote in the paperNot a substantial claim
60 of 60

  • The paper relies on this without support.

    There is limited evidence evaluating current integrated virtual care interventions in diabetes management, including more recent video conferencing technology.

    “However, with the recent rapid shift to virtual care, there is still limited evidence when it comes to the evaluation of current integrated virtual care interventions in diabetes management, including more recent video conferencing technology.”

  • The paper relies on this without support.

    The diverse virtual care interventions included in the reviews are sufficiently comparable to be synthesised into an overall assessment of virtual care effectiveness.

    “All the reviews included a wide range of virtual care interventions, often combining different approaches to support clinical management, such as personalised interactions or feedback between providers and individuals with diabetes.”
    “Since all the interventions incorporated management and/or communication systems as integral components of virtual care, it was not feasible to align within a specific framework based on intended purpose and eHealth classification [50].”

  • The paper relies on this without support.

    The 47.7% overlap among primary studies does not invalidate the meta-analysis estimates.

    “This 47.7% overlap affects the accuracy of our meta-analysis estimates, as it represents a significant portion of the research would have been duplicated in our meta-analysis.”
    “Therefore, we included this overlap number as a potential limitation that may have impacted the estimates, but we have not mitigated it as such in our analysis.”

  • The paper relies on this without support.

    Reporting bias within the included reviews did not substantially bias the findings.

    “In addition, it is possible that reporting bias within the included reviews could have impacted which studies were included, which may have also biased our findings.”

  • The paper relies on this without support.

    Pooling data from mixed diabetes populations does not obscure the true effects specifically for individuals with type 2 diabetes.

    “As a result, the findings may be biased, as they have pooled data from mixed type of diabetes populations, potentially obscuring the true effects specifically for individuals with type 2 diabetes.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Intervention-duration summary conflicts with Su review

    Major

    The timeframe section says the cited reviews favour programs of at least six months over shorter programs. Table 1 instead says Su [29] found interventions of six months or less more effective than longer programs.

  • Abstract claims a significant BMI impact contrary to the BMI analysis

    Major

    The abstract reports a significant impact on BMI, while the BMI meta-analysis explicitly reports no statistically significant difference.

  • Correia video estimate lies outside its reported confidence interval

    Major

    The reported mean difference of −0.89% is below the reported confidence interval's lower bound of −0.85%.

  • Robson HbA1c interval conflicts with claimed significance

    Minor

    The reported confidence interval extends from a positive value to a negative value and therefore includes zero, despite the row calling the reduction significant.

  • Appraisal percentage uses the wrong denominator

    Minor

    The text says "Of those" 22 reviews, 12 had at least two appraisers. That is 54.5%, not 40.0%; 40.0% uses all 30 reviews as the denominator.

    Reported 40 · recomputed 54.545455

  • Blood-pressure summary conflicts with Marcolino review

    Minor

    The results say all seven listed reviews, including Marcolino [37], reported reduced blood pressure. Table 1 says Marcolino found no effect on blood pressure.

  • Hu BMI estimate lies outside its reported confidence interval

    Minor

    The reported BMI mean difference of −0.27 lies outside the stated interval of −0.86 to −0.31. The interval also conflicts with the row's statement that the effect was not significant.

  • Type 2 diabetes result is called statistically significant despite a CI spanning zero

    Minor

    The discussion calls the 0.41% type 2 diabetes reduction statistically significant, but the reported confidence interval for that estimate runs from −0.49 to 0.34 and includes zero.

8 of 8

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org.

Cited by

Sorted by citations

Related

Authors
Ravi, S., Meyerowitz-Katz, G., Yung, C., Ayre, J., McCaffery, K., Maberly, G., & Bonner, C.
Affiliations
The University of Sydney (AU)
Corresponding author
Ravi, Sumathy
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2025-03-06
Volume
25
Issue
1
Pages
348-348
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/s12913-025-12496-0
PMC
PMC11884068
OpenAlex
W4408204132
Semantic Scholar
5d2a4d2cdfa2800d4120a0af771f453b4aa8aec3
Cited by
19
References
50
Citations by year
2026: 14 · 2025: 5
FWCI
3.66
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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
virtual care, type 2 diabetes, telemedicine, HbA1c, glycemic control, body mass index, medication adherence, self-management behavior, video-based intervention, primary care
MeSH terms
Systematic Reviews as Topic, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Telemedicine

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-29.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-29.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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