Michaud Tzeyu L, Ern Jessica, Scoggins Dylan, Su Dejun
Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Telemed J E Health. 2021 Feb;27(2):124-136. doi: 10.1089/tmj.2019.0319. Epub 2020 May 11.
Lifestyle modification to promote regular physical activity and healthy eating is a key element of diabetes management. We aimed at evaluating randomized controlled trials that assess the impact of telemonitoring on diabetes outcomes with the inclusion of lifestyle change components. A systematic review search in relevant databases was conducted for studies published from January 2000 to October 2018. The search was restricted to studies published in English and included adult patients with type 2 diabetes. Study selection criteria included telehealth programs with remote monitoring of physiological data and feedback features. We further performed meta-analyses to summarize the pooled effect size (presented by the mean difference [MD]) of hemoglobin A1c (HbA1c) and weight loss outcomes. Seventeen studies were included in the data synthesis (15 of them were included in the meta-analysis), with the sample size ranging from 18 to 484 and the study period ranging from 3 to 12 months. Telemonitoring achieved a significant but modest reduction in HbA1c (MD = -0.30%; 95% confidence interval [CI]: -0.31% to -0.29%) and weight loss (kg) outcomes (MD = -0.62; 95% CI: -0.78 to -0.45) compared with usual care. In the subgroup analyses, it was suggested that telemonitoring with automatic mobile transmission or with real-time feedback modality led to a greater improvement in HbA1c outcomes (MD = -0.61% and -0.77%, respectively) when compared with telemonitoring without these features. Telemonitoring has a great potential to further enhance diabetes management with the inclusion of a system approach for supporting patients' lifestyle changes. Features such as automatic mobile transmission and real-time feedback show promise to boost effectiveness of telemonitoring in diabetes management in the future.
通过改变生活方式来促进规律的体育活动和健康饮食是糖尿病管理的关键要素。我们旨在评估随机对照试验，这些试验评估远程监测对糖尿病结局的影响，并纳入生活方式改变的组成部分。我们在相关数据库中进行了系统回顾搜索，以查找2000年1月至2018年10月发表的研究。搜索仅限于以英文发表的研究，并纳入成年2型糖尿病患者。研究选择标准包括具有生理数据远程监测和反馈功能的远程医疗项目。我们进一步进行了荟萃分析，以总结糖化血红蛋白（HbA1c）和体重减轻结局的合并效应量（以平均差[MD]表示）。数据综合纳入了17项研究（其中15项纳入荟萃分析），样本量从18至484不等，研究期从3至12个月。与常规护理相比，远程监测使HbA1c（MD = -0.30%；95%置信区间[CI]：-0.31%至-0.29%）和体重减轻（千克）结局有显著但适度的降低（MD = -0.62；95%CI：-0.78至-0.45）。在亚组分析中，结果表明，与不具备这些功能的远程监测相比，采用自动移动传输或实时反馈模式的远程监测在HbA1c结局方面有更大改善（MD分别为-0.61%和-0.77%）。通过纳入支持患者生活方式改变的系统方法，远程监测在进一步加强糖尿病管理方面具有巨大潜力。自动移动传输和实时反馈等功能有望在未来提高远程监测在糖尿病管理中的有效性。
