Efficacy of telemedicine intervention in the self-management of patients with type 2 diabetes: a systematic review and meta-analysis
Open accessAbstract
Purpose: We aimed to report the latest and largest pooled analyses and evidence updates to assess the effectiveness of telemedicine interventions for self-management (DSM) in patients with type 2 diabetes mellitus (T2DM). Methods: A systematic literature search was conducted using PubMed, Cochrane, Embase, and Web of Science in December 2023. We included randomized controlled trials (RCTs) of adults (≥18 years of age) diagnosed with T2DM where the intervention was the application of telemedicine. The Cochrane Risk of Bias Assessment was used to evaluate quality. The study’s main outcome indicators were glycosylated hemoglobin (HbA1c) and diabetes self-management (DSM) capacity. Results: A total of 17 eligible articles, comprising 20 studies and 1,456 patients (734 in the intervention group and 722 in the control group), were included in the evidence synthesis. The baseline characteristics of both groups were similar in all outcomes. Comprehensive analyses showed post-intervention decreases in HbA1c, 2-h postprandial glucose, systolic and diastolic blood pressure, increases in Diabetes Self- Care activities, DSM competencies based on dietary and medication adherence, and improvements in overall DSM scores, all of which were statistically significant. While no statistically significant differences were observed in body mass index, lipids, and other DSM dimensions. Based on subgroup analyses, app-based experimental interventions targeting under 60 years old populations in Asia and North America were found to be more effective and less heterogeneity in the short term (<6 months of intervention). Conclusion: Telemedicine interventions may assist patients with T2DM in enhancing their DSM and improving their HbA1c levels. Clinician can use various telemedicine interventions to enhance DSM in T2DM patients, considering local circumstances. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, CRD42024508522.
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Telemedicine supported by mHealth seemed to be more frequently associated with improved glycaemic control, whilst past evidence did not consistently demonstrate a clear benefit of telemedicine on metabolic control.
“In these cases, telemedicine supported by mHealth seemed to be more frequently associated with improved glycaemic control, whilst past evidence did not consistently demonstrate a clear benefit of telemedicine on metabolic control (7–9).”
From Impact of digital health on Type 2 diabetes management: a randomised controlled trial of the ‘TreC Diabete’ platform (TELEMECHRON Study) (2025) · cites this paper as [7]
The Discussion (page unavailable) reports significant HbA1c reductions with app, app-plus-telephone, and telephone interventions, supporting the association with improved glycaemic control. It does not characterize past evidence as lacking a consistent benefit: it says its blood-glucose findings are consistent with previous systematic reviews. Its own analysis found no relevant effect on fasting plasma glucose, but that does not establish the claim about past evidence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe clinical effectiveness of mHealth tools, including those delivered via telemedicine platforms, remains inconsistent, with some studies showing limited or variable impact on metabolic outcomes.
“However, the clinical effectiveness of mHealth tools, including those delivered via telemedicine platforms, remains inconsistent, with some studies showing limited or variable impact on metabolic, and in the large majority of cases studies were assessing a single-function application.”
From Impact of digital health on Type 2 diabetes management: a randomised controlled trial of the ‘TreC Diabete’ platform (TELEMECHRON Study) (2025) · cites this paper as [7]
The Discussion reports mixed metabolic results in patients with type 2 diabetes: telemedicine improved HbA1c and several other measures, but showed no relevant effect on fasting glucose or BMI, and weight and blood-pressure results were unstable. This supports variable effects in the studied population, not a general conclusion that mHealth tools are clinically inconsistent. The Descriptions of studies section also does not support the citing sentence’s assertion that a large majority assessed single-function applications. (LLM, conf=0.85)
Experimental — accuracy not yet measuredA 2024 meta-analysis by Liu et al., incorporating 1,456 patients, confirmed that telemedicine significantly enhanced self-management and lowered blood glucose levels in T2DM patients.
“Furthermore, a 2024 meta-analysis from Liu and colleagues, incorporating data from 1,456 patients and different telemedicine solutions, confirmed that telemedicine significantly enhanced self-management and lowered blood glucose levels in T2DM patients (7).”
From Impact of digital health on Type 2 diabetes management: a randomised controlled trial of the ‘TreC Diabete’ platform (TELEMECHRON Study) (2025) · cites this paper as [7]
Subgroup analyses revealed greatest efficacy in younger patients, interventions under six months, and the use of apps and telephones.
“Subgroup analyses revealed the greatest efficacy in younger patients, interventions under six months, and the use of apps and telephones.”
From Impact of digital health on Type 2 diabetes management: a randomised controlled trial of the ‘TreC Diabete’ platform (TELEMECHRON Study) (2025) · cites this paper as [7]
In that meta-analysis, improvements were seen in HbA1c, two-hours post-prandial glucose, weight, SBP, and DBP, but not on BMI and Fasting Plasma Glucose.
“Key improvements were also seen in HbA1c, two-hours post-prandial glucose, weight, SBP, and DBP, but not on BMI and Fasting Plasma Glucose.”
From Impact of digital health on Type 2 diabetes management: a randomised controlled trial of the ‘TreC Diabete’ platform (TELEMECHRON Study) (2025) · cites this paper as [7]
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Giovanazzi, A., Gios, L., Gentilini, M. A., Mastellaro, M., Bartolotta, P., Nicolussi Giacomaz, L., Eccher, C., & Inchiostro, S. (2025) · Frontiers in Clinical Diabetes and Healthcare · doi:10.3389/fcdhc.2025.1589548 · Cited by 2 · see citing works
- Authors
- Liu, F., Li, J., Li, X., Yang, Z., Wang, W., Zhao, L., Wu, T., Huang, C., & Xu, Y.
- Affiliations
- Shandong University of Traditional Chinese Medicine (CN)
- Xiyuan Hospital (CN)
- Wangjing Hospital of China Academy of Chinese Medical Sciences (CN)
- Heilongjiang University of Chinese Medicine (CN)
- Corresponding author
- Xu, Yunsheng
- Venue
- Frontiers in Public Health
- Publisher
- Frontiers Media SA
- Published
- 2024-05-21
- Volume
- 12
- Pages
- 1405770-1405770
- ISSN
- 2296-2565 (ISSN-L)
- PMC
- PMC11148367
- OpenAlex
- W4398174580
- Cited by
- 22
- References
- 50
- Citations by year
- 2026: 11 · 2025: 10 · 2024: 1
- FWCI
- 1.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Key Research and Development Program of China (2023YFC3606200, 2018YFC1704103)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- telemedicine, type 2 diabetes, diabetes self-management, HbA1c, postprandial blood glucose, blood pressure, medication adherence, dietary adherence, mobile health apps, diabetes self-care
- MeSH terms
- Self-Management, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Middle Aged, Randomized Controlled Trials as Topic, Telemedicine
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