Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
Ulcer and Wound Healing Consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.
Front Endocrinol (Lausanne). 2022 Mar 15;13:848695. doi: 10.3389/fendo.2022.848695. eCollection 2022.
Remotely delivered interventions may be more efficient in controlling multiple risk factors in people with diabetes.
To pool evidence from randomized controlled trials testing remote management interventions to simultaneously control blood pressure, blood glucose and lipids.
PubMed/Medline, EMBASE, CINAHL and the Cochrane library were systematically searched for randomized controlled trials (RCTs) until 20 June 2021.
Included RCTs were those that reported participant data on blood pressure, blood glucose, and lipid outcomes in response to a remotely delivered intervention.
Three authors extracted data using a predefined template. Primary outcomes were glycated hemoglobin (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), systolic and diastolic blood pressure (SBP & DBP). Risk of bias was assessed using the Cochrane collaboration RoB-2 tool. Meta-analyses are reported as standardized mean difference (SMD) with 95% confidence intervals (95%CI).
Twenty-seven RCTs reporting on 9100 participants (4581 intervention and 4519 usual care) were included. Components of the remote management interventions tested were identified as patient education, risk factor monitoring, coaching on monitoring, consultations, and pharmacological management. Comparator groups were typically face-to-face usual patient care. Remote management significantly reduced HbA1c (SMD -0.25, 95%CI -0.33 to -0.17, p<0.001), TC (SMD -0.17, 95%CI -0.29 to -0.04, p<0.0001), LDL-c (SMD -0.11, 95%CI -0.19 to -0.03, p=0.006), SBP (SMD -0.11, 95%CI -0.18 to -0.04, p=0.001) and DBP (SMD -0.09, 95%CI -0.16 to -0.02, p=0.02), with low to moderate heterogeneity (I²= 0 to 75). Twelve trials had high risk of bias, 12 had some risk and three were at low risk of bias.
Heterogeneity and potential publication bias may limit applicability of findings.
Remote management significantly improves control of modifiable risk factors.
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258433], identifier PROSPERO (CRD42021258433).
远程干预措施可能更有效地控制糖尿病患者的多种风险因素。
汇总测试远程管理干预措施以同时控制血压、血糖和血脂的随机对照试验的证据。
系统检索了 PubMed/Medline、EMBASE、CINAHL 和 Cochrane 图书馆，以获取截至 2021 年 6 月 20 日的随机对照试验（RCT）的相关信息。
纳入的 RCT 报告了参与者对远程干预的血压、血糖和血脂结果的反应数据。
三位作者使用预定义模板提取数据。主要结局指标为糖化血红蛋白（HbA1c）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-c）、收缩压和舒张压（SBP 和 DBP）。使用 Cochrane 协作 RoB-2 工具评估偏倚风险。荟萃分析以标准化均数差（SMD）和 95%置信区间（95%CI）报告。
纳入了 27 项 RCT，共涉及 9100 名参与者（4581 名干预组和 4519 名常规护理组）。远程管理干预措施的组成部分被确定为患者教育、风险因素监测、监测指导、咨询和药物管理。对照组通常为面对面的常规患者护理。远程管理显著降低了 HbA1c（SMD-0.25，95%CI-0.33 至-0.17，p<0.001）、TC（SMD-0.17，95%CI-0.29 至-0.04，p<0.0001）、LDL-c（SMD-0.11，95%CI-0.19 至-0.03，p=0.006）、SBP（SMD-0.11，95%CI-0.18 至-0.04，p=0.001）和 DBP（SMD-0.09，95%CI-0.16 至-0.02，p=0.02），异质性为低至中度（I²=0 至 75）。12 项试验存在高偏倚风险，12 项试验存在一定风险，3 项试验存在低偏倚风险。
异质性和潜在的发表偏倚可能限制了研究结果的适用性。
远程管理显著改善了可改变风险因素的控制。
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258433]，标识符 PROSPERO（CRD42021258433）。
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