General Practice Department, Peking University First Hospital, Beijing, China.
Family Medicine Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
BMJ Open Diabetes Res Care. 2023 Feb;11(1). doi: 10.1136/bmjdrc-2022-003180.
The popularity of teleconsultation during the COVID-19 pandemic enabled increased accessibility for individuals with type 2 diabetes mellitus (T2DM). However, previous studies did not distinguish between synchronous and asynchronous teleconsultation. We evaluated the effectiveness of synchronous teleconsultation for patients with T2DM. We searched Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library and Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform databases from inception to July 2021. All included studies were randomized controlled trials of synchronous teleconsultation for adults with T2DM compared with usual care. Reviewers independently extracted data and used the Cochrane tool to evaluate risk of bias. Meta-analyses were conducted using random-effects models. A pooled mean difference for both HbA1c (%) and body mass index (BMI) (kg/m), systolic blood pressure (SBP) (mm Hg), diastolic blood pressure (DBP) (mm Hg), and low density lipoprotein cholesterol (LDL-cholesterol) (mg/dL) were calculated. Patient-reported outcomes, such as depression, medication adherence, and quality of life, were also assessed. A total of 9807 abstracts were identified and 27 trials were included. Synchronous teleconsultation significantly resulted in greater decrease in HbA1c compared with usual care group (n=8746, 0.35, 95% CI 0.20 to 0.49, I=73%, p<0.001). No significant effects on BMI (n=699, 0.08 kg/m, 95% CI -0.54 to 0.69), SBP (n=5512, 1.32 mm Hg, 95% CI -0.09 to 2.73), DBP (n=2898, 0.17 mm Hg, 95% CI -1.18 to 1.52), or LDL-cholesterol (n=5276, 3.21 mg/dL, 95% CI -1.75 to 8.17) were found. The effect of teleconsultation in improving patient-reported outcomes was uncertain. Thus, synchronous teleconsultation could be an alternative to usual care. Systematic review registration is PROSPERO CRD42021267019.
在 COVID-19 大流行期间，远程会诊的普及使得 2 型糖尿病（T2DM）患者更容易获得医疗服务。然而，之前的研究并没有区分同步和异步远程会诊。我们评估了同步远程会诊对 T2DM 患者的有效性。我们检索了 Medline、Embase、Cochrane 对照试验中心注册库、Cochrane 图书馆和 Cochrane 系统评价数据库、ClinicalTrials.gov 以及世界卫生组织国际临床试验注册平台数据库，检索时间从建库至 2021 年 7 月。所有纳入的研究均为比较同步远程会诊与常规护理治疗成人 T2DM 的随机对照试验。审查员独立提取数据，并使用 Cochrane 工具评估偏倚风险。Meta 分析采用随机效应模型进行。计算了糖化血红蛋白（HbA1c）（%）和体重指数（BMI）（kg/m2）、收缩压（SBP）（mmHg）、舒张压（DBP）（mmHg）和低密度脂蛋白胆固醇（LDL-cholesterol）（mg/dL）的汇总均差。还评估了患者报告的结局，如抑郁、药物依从性和生活质量。共确定了 9807 篇摘要，纳入了 27 项试验。与常规护理组相比，同步远程会诊显著降低了 HbA1c（n=8746，0.35，95%CI 0.20 至 0.49，I=73%，p<0.001）。对 BMI（n=699，0.08 kg/m2）、SBP（n=5512，1.32 mmHg）、DBP（n=2898，0.17 mmHg）或 LDL-cholesterol（n=5276，3.21 mg/dL）无显著影响，95%CI 分别为 -0.54 至 0.69、-0.09 至 2.73、-1.18 至 1.52 和 -1.75 至 8.17。远程会诊改善患者报告结局的效果不确定。因此，同步远程会诊可能是常规护理的一种替代方法。系统评价注册是 PROSPERO CRD42021267019。
