Department of Medicine, Geneva University Hospitals, Chemin Venel 7, 1206 Geneva, Switzerland.
Faculty of Life Sciences and Education, University of South Wales, Pontypridd, Wales.
Bull World Health Organ. 2021 Mar 1;99(3):209-219B. doi: 10.2471/BLT.19.250068. Epub 2020 Nov 29.
To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries.
We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties.
We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of -0.38 for glycated haemoglobin (95% confidence interval, CI: -0.52 to -0.23; = 86.70%), -0.20 for fasting blood sugar (95% CI: -0.32 to -0.08; = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; = 93.75%), 0.55 for diabetes knowledge (95% CI: -0.10 to 1.20; = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of -0.04 for body mass index (95% CI: -0.13 to 0.05; = 35.94%), -0.06 for total cholesterol (95% CI: -0.16 to 0.04; = 59.93%) and -0.02 for triglycerides (95% CI: -0.12 to 0.09; = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications.
Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.
评估远程医疗在中低收入国家提供糖尿病护理方面的效果。
我们检索了截至 2020 年 7 月的七个数据库，以确定在中低收入国家提供糖尿病护理的远程医疗的有效性。我们提取了研究特征、主要终点和结果的效果大小的数据。我们使用随机效应分析，对生化结果和相关患者特征进行了一系列荟萃分析。
我们的荟萃分析纳入了 31 项干预措施。我们观察到糖化血红蛋白的标准化均数差有显著意义，为 -0.38（95%置信区间：-0.52 至 -0.23； = 86.70%），空腹血糖为 -0.20（95%置信区间：-0.32 至 -0.08； = 64.28%），治疗依从性为 0.81（95%置信区间：0.19 至 1.42； = 93.75%），糖尿病知识为 0.55（95%置信区间：-0.10 至 1.20； = 92.65%），自我效能为 1.68（95%置信区间：1.06 至 2.30； = 97.15%）。我们没有观察到其他结局的治疗效果有显著意义，标准化均数差分别为体重指数 -0.04（95%置信区间：-0.13 至 0.05； = 35.94%），总胆固醇 -0.06（95%置信区间：-0.16 至 0.04； = 59.93%）和甘油三酯 -0.02（95%置信区间：-0.12 至 0.09； = 0%）。与基于遥测和智能手机应用的服务相比，通过电话和短信服务的干预措施产生了最高的治疗效果。
尽管我们确定远程医疗在改善多项糖尿病相关结局方面是有效的，但由于存在很大的异质性和偏倚风险，证据的确定性非常低。
