Medicine with specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany.
J Med Internet Res. 2021 Feb 19;23(2):e23244. doi: 10.2196/23244.
Diabetes mellitus (DM) is one of the world's greatest health threats with rising prevalence. Global digitalization leads to new digital approaches in diabetes management, such as telemedical interventions. Telemedicine, which is the use of information and communication technologies, may provide medical services over spatial distances to improve clinical patient outcomes by increasing access to diabetes care and medical information.
This study aims to examine whether telemedical interventions effectively improve diabetes control using studies that pooled patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), and whether the benefits are greater in patients diagnosed with T2DM than in those diagnosed with T1DM. We analyzed the primary outcome glycated hemoglobin A (HbA) and the secondary outcomes fasting blood glucose (FBG), blood pressure (BP), body weight, BMI, quality of life (QoL), cost, and time saving.
Publications were systematically identified by searching Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, Embase, and CINAHL databases for studies published between January 2008 and April 2020, considering systematic reviews (SRs), meta-analyses (MAs), randomized controlled trials (RCTs), and clinical trials (CTs). Study quality was assessed using the A Measurement Tool to Assess Systematic Reviews, Effective Public Health Practice Project, and National Institute for Health and Care Excellence qualitative checklist. We organized the trials by communication technologies in real-time video or audio interventions, asynchronous interventions, and combined interventions (synchronous and asynchronous communication).
From 1116 unique citations, we identified 31 eligible studies (n=15 high, n=14 moderate, n=1 weak, and n=1 critically low quality). We selected 21 SRs and MAs, 8 RCTs, 1 non-RCT, and 1 qualitative study. Of the 10 trials, 3 were categorized as real-time video, 1 as real-time video and audio, 4 as asynchronous, and 2 as combined intervention. Significant decline in HbA levels based on pooled T1DM and T2DM patients data ranged from -0.22% weighted mean difference (WMD; 95% CI -0.28 to -0.15; P<.001) to -0.64% mean difference (95% CI -1.01 to -0.26; P<.001). The intervention effect on lowering HbA values might be significantly smaller for patients with T1DM than for patients with T2DM. Evidence on the impact on BP, body weight, FBG, cost effectiveness, and time saving was smaller compared with HbA but indicated potential in some publications.
Telemedical interventions might be clinically effective in improving diabetes control overall, and they might significantly improve HbA concentrations. Patients with T2DM could benefit more than patients with T1DM regarding lowering HbA levels. Further studies with longer duration and larger cohorts are necessary.
糖尿病是世界上最大的健康威胁之一，其患病率不断上升。全球数字化导致了糖尿病管理中的新的数字方法，例如远程医疗干预。远程医疗是指利用信息和通信技术，可以通过增加获得糖尿病护理和医疗信息的机会，来提供跨越空间距离的医疗服务，从而改善临床患者的结局。
本研究旨在通过汇集 1 型糖尿病（T1DM）和 2 型糖尿病（T2DM）患者的研究，考察远程医疗干预是否能有效改善糖尿病控制，并探讨其在 T2DM 患者中的疗效是否优于 T1DM 患者。我们分析了主要结局糖化血红蛋白 A（HbA）以及次要结局空腹血糖（FBG）、血压（BP）、体重、BMI、生活质量（QoL）、成本和节省时间。
系统检索 Cochrane 图书馆、通过 PubMed 检索 MEDLINE、Web of Science 核心合集、Embase 和 CINAHL 数据库，检索 2008 年 1 月至 2020 年 4 月发表的研究，包括系统评价（SRs）、荟萃分析（MAs）、随机对照试验（RCTs）和临床试验（CTs）。使用 A 测量工具评估系统评价、有效公共卫生实践项目和国家卫生与护理卓越研究所定性清单评估研究质量。我们根据实时视频或音频干预、异步干预和组合干预（同步和异步通信）的通信技术对试验进行了分类。
从 1116 条独特的引用中，我们确定了 31 项符合条件的研究（n=15 项高质量、n=14 项中质量、n=1 项低质量和 n=1 项极低质量）。我们选择了 21 项 SRs 和 MAs、8 项 RCTs、1 项非 RCT 和 1 项定性研究。其中 10 项试验中，3 项为实时视频，1 项为实时视频和音频，4 项为异步，2 项为组合干预。基于汇集的 T1DM 和 T2DM 患者数据，HbA 水平的显著下降幅度范围为-0.22%（加权均数差，95%CI -0.28 至 -0.15；P<.001）至-0.64%（95%CI -1.01 至 -0.26；P<.001）。与 T2DM 患者相比，T1DM 患者的干预对降低 HbA 值的效果可能较小。与 HbA 相比，BP、体重、FBG、成本效益和节省时间的影响证据较小，但在一些出版物中表明具有潜在获益。
远程医疗干预可能在改善总体糖尿病控制方面具有临床效果，并且可能显著降低 HbA 浓度。T2DM 患者在降低 HbA 水平方面可能比 T1DM 患者获益更多。需要进一步开展具有更长时间和更大样本量的研究。
