远程医疗在妊娠期糖尿病管理中的有效性：系统评价和荟萃分析。
Effectiveness of Telemedicine in Managing Diabetes in Pregnancy: A Systematic Review and Meta-Analysis.
机构信息
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
University College of Northern Denmark, Aalborg, Denmark.
出版信息
J Diabetes Sci Technol. 2023 Sep;17(5):1364-1375. doi: 10.1177/19322968221094626. Epub 2022 May 9.
BACKGROUND
Strict monitoring of blood glucose during pregnancy is essential for ensuring optimal maternal and neonatal outcomes. Telemedicine could be a promising solution for supporting diabetes management; however, an updated meta-analysis is warranted. This study assesses the effects of telemedicine solutions for managing gestational and pregestational diabetes.
METHODS
PubMed, EMBASE, Cochrane Library Central Register of Controlled Trials, and CINAHL were searched up to October 14, 2020. All randomized trials assessing the effects of telemedicine in managing diabetes in pregnancy relative to any comparator without the use of telemedicine were included. The primary outcome was infant birth weight. A meta-analysis comparing the mean difference (MD) in birth weight across studies was applied, and subgroup and sensitivity analyses were performed. The revised Cochrane tool was applied to assess the risk of bias, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
RESULTS
From a total of 18 studies, ten (totaling 899 participants) were used to calculate the effect on infant birth weight. The results nonsignificantly favored the control (MD of 19.34 g; [95% confidence interval, CI -47.8; 86.47]), with moderate effect certainty. Heterogeneity was moderate ( = 37.39%). Statistically significant secondary outcomes included differences in two-hour glucose tolerance postpartum (gestational diabetes; two studies: standardized mean difference 9.62 mg/dL [95% CI: 1.95; 17.28]) that favored the control (GRADE level, very low) and risk of shoulder dystocia (four studies: log odds -1.34 [95% CI: -2.61; -0.08]) that favored telemedicine (GRADE, low).
CONCLUSIONS
No evidence was found to support telemedicine as an alternative to usual care when considering maternal and fetal outcomes. However, further research is needed, including economic evaluations.
背景
严格监测妊娠期间的血糖对于确保母婴的最佳结局至关重要。远程医疗可能是支持糖尿病管理的一种很有前途的解决方案；然而，需要进行更新的荟萃分析。本研究评估了远程医疗解决方案在管理妊娠和孕前糖尿病方面的效果。
方法
截至 2020 年 10 月 14 日，检索了 PubMed、EMBASE、Cochrane 图书馆对照试验中心注册库和 CINAHL。纳入了所有评估与不使用远程医疗的任何对照相比，远程医疗在管理妊娠糖尿病方面效果的随机试验。主要结局是婴儿出生体重。应用比较研究间出生体重均数差（MD）的荟萃分析，并进行了亚组和敏感性分析。应用修订后的 Cochrane 工具评估偏倚风险，并使用推荐、评估、开发和评估（GRADE）方法评估证据确定性。
结果
共有 18 项研究，其中 10 项（共 899 名参与者）用于计算对婴儿出生体重的影响。结果无统计学意义地倾向于对照组（MD 为 19.34 g；[95%置信区间，CI -47.8；86.47]），证据确定性为中等。异质性为中度（ = 37.39%）。有统计学意义的次要结局包括产后两小时葡萄糖耐量的差异（妊娠期糖尿病；两项研究：标准化均数差 9.62 mg/dL [95% CI：1.95；17.28]），对照组有利（GRADE 水平，极低），肩难产风险的差异（四项研究：对数优势比-1.34 [95% CI：-2.61；-0.08]），有利于远程医疗（GRADE，低）。
结论
没有证据支持将远程医疗作为常规护理的替代方案，在考虑母婴结局时。然而，需要进一步研究，包括经济评估。
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