Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Korea.
Division of Research Planning and Coordination, National Evidence-based Healthcare Collaborating Agency, Korea.
J Telemed Telecare. 2019 Dec;25(10):587-601. doi: 10.1177/1357633X18782599. Epub 2018 Jul 17.
This study evaluated clinical effectiveness of telemonitoring on the management of patients with type 2 diabetes.
We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane Library to identify randomized controlled trials that compared telemonitoring and usual care in patients with type 2 diabetes.
Thirty-eight studies (6855 patients) were included. Telemonitoring was associated with a significant decrease in glycated haemoglobin levels compared to usual care (weighted mean difference -0.42%, 95% confidence interval -0.56 to -0.27) but there was evidence of heterogeneity (= 96.9%). Telemonitoring was associated with a significant glycated haemoglobin reduction when biological data were transmitted through a web-based device weekly, when voice feedback was performed daily or immediately and when patients were provided with counselling. Telemonitoring also reduced glycated haemoglobin level in studies that monitored patients' medication adherence, provided counselling, education and alarm message. The rate of achieving glycated haemoglobin levels of < 7% was 1.8 times higher in the telemonitoring group compared to the usual care group (risk ratio 1.83, 95% confidence interval 1.35 to 2.47, = 0%). There was also significant reduction in systolic blood pressure (weighted mean difference -1.33 mm Hg) and body mass index (weighted mean difference -0.25 kg/m), but the clinical relevance of these results can be questioned. The data available on patient satisfaction, quality of life, medication adherence, prescription changes, stress and depression were limited.
Telemonitoring interventions may be a better option than usual care in improving glycated haemoglobin control of patients with type 2 diabetes. Further studies should assess clinical benefit according to specific delivery modes of the intervention and patient-reported outcomes.
本研究评估了远程监测在 2 型糖尿病患者管理中的临床效果。
我们检索了 Ovid-Medline、Ovid-EMBASE 和 Cochrane 图书馆，以确定比较 2 型糖尿病患者远程监测和常规护理的随机对照试验。
共纳入 38 项研究（6855 例患者）。与常规护理相比，远程监测可显著降低糖化血红蛋白水平（加权均数差-0.42%，95%置信区间-0.56 至-0.27），但存在高度异质性（=96.9%）。当通过基于网络的设备每周传输生物数据、每日或立即进行语音反馈以及为患者提供咨询时，远程监测与显著的糖化血红蛋白降低相关。当监测患者的药物依从性、提供咨询、教育和警报信息时，远程监测也可降低糖化血红蛋白水平。与常规护理组相比，远程监测组糖化血红蛋白水平<7%的达标率高 1.8 倍（风险比 1.83，95%置信区间 1.35 至 2.47，=0.000）。收缩压（加权均数差-1.33mmHg）和体重指数（加权均数差-0.25kg/m2）也有显著降低，但这些结果的临床相关性值得质疑。关于患者满意度、生活质量、药物依从性、处方改变、压力和抑郁的数据有限。
与常规护理相比，远程监测干预可能是改善 2 型糖尿病患者糖化血红蛋白控制的更好选择。进一步的研究应根据干预措施的具体传递模式和患者报告的结果评估临床获益。
