Cited by 281Telemedicine and Telehealth ImplementationDiabetes Management and EducationDiabetes Management and Research

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Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials

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Faruque, Labib Imran, Wiebe, Natasha, Ehteshami-Afshar, Arash, Liu, Yuanchen, Dianati-Maleki, Neda, Hemmelgarn, Brenda R., Manns, Braden J., Tonelli, Marcello·2017·Canadian Medical Association Journal

Abstract

BACKGROUND: Telemedicine, the use of telecommunications to deliver health services, expertise and information, is a promising but unproven tool for improving the quality of diabetes care. We summarized the effectiveness of different methods of telemedicine for the management of diabetes compared with usual care. METHODS: We searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials databases (to November 2015) and reference lists of existing systematic reviews for randomized controlled trials (RCTs) comparing telemedicine with usual care for adults with diabetes. Two independent reviewers selected the studies and assessed risk of bias in the studies. The primary outcome was glycated hemoglobin (HbA1C) reported at 3 time points (≤ 3 mo, 4–12 mo and > 12 mo). Other outcomes were quality of life, mortality and episodes of hypoglycemia. Trials were pooled using randomeffects meta-analysis, and heterogeneity was quantified using the I2 statistic. RESULTS: From 3688 citations, we identified 111 eligible RCTs (n = 23 648). Telemedicine achieved significant but modest reductions in HbA1C in all 3 follow-up periods (difference in mean at ≤ 3 mo: −0.57%, 95% confidence interval [CI] −0.74% to −0.40% [39 trials]; at 4–12 mo: −0.28%, 95% CI −0.37% to −0.20% [87 trials]; and at > 12 mo: −0.26%, 95% CI −0.46% to −0.06% [5 trials]). Quantified heterogeneity (I2 statistic) was 75%, 69% and 58%, respectively. In meta-regression analyses, the effect of telemedicine on HbA1C appeared greatest in trials with higher HbA1C concentrations at baseline, in trials where providers used Web portals or text messaging to communicate with patients and in trials where telemedicine facilitated medication adjustment. Telemedicine had no convincing effect on quality of life, mortality or hypoglycemia. INTERPRETATION: Compared with usual care, the addition of telemedicine, especially systems that allowed medication adjustments with or without text messaging or a Web portal, improved HbA1C but not other clinically relevant outcomes among patients with diabetes.

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Crossref · 10.1503/cmaj.150885

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    Telemedicine may be helpful for providing care to people with diabetes, especially those unable to travel to health care facilities because of large distances or disabilities.

    “It may also be helpful for providing care to people with diabetes, especially those unable to travel to health care facilities owing to large distances or disabilities.”
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Metadata

Authors
Faruque, L. I., Wiebe, N., Ehteshami-Afshar, A., Liu, Y., Dianati-Maleki, N., Hemmelgarn, B. R., Manns, B. J., & Tonelli, M.
Affiliations
University of Alberta (CA)
Venue
Canadian Medical Association Journal
Published
2016-10-31
Volume
189
Issue
9
Pages
E341-E364
ISSN
  • 0820-3946 (ISSN-L)
  • 1488-2329
OpenAlex
W2546067499
Cited by
281
References
187
Citations by year
2026: 14 · 2025: 25 · 2024: 33 · 2023: 29 · 2022: 46 · 2021: 46 · 2020: 32 · 2019: 25 · 2018: 18 · 2017: 12 · 2016: 1
FWCI
2.76
Type
journal article
Language
en
Open access
Locations
  • Canadian Medical Association Journal (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
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, HbA1c, glycemic control, diabetes management, web portal, text messaging, medication adjustment, quality of life, hypoglycemia, mortality
MeSH terms
Communication, Diabetes Mellitus, Glycated Hemoglobin, Humans, Hypoglycemia, Quality of Life, Randomized Controlled Trials as Topic, Telemedicine, Disease Management, Internet, Text Messaging

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