远程医疗提供的碳水化合物计数干预措施对1型糖尿病患者的有效性：系统评价和荟萃分析。

Effectiveness of Telemedicine-Delivered Carbohydrate-Counting Interventions in Patients With Type 1 Diabetes: Systematic Review and Meta-Analysis.

作者信息

Li Yang, Yang Yue, Liu Xiaoqin, Zhang Xinting, Li Fei

机构信息

Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin, China.

School of Nursing, Jilin University, Changchun, China.

出版信息

J Med Internet Res. 2025 Apr 10;27:e59579. doi: 10.2196/59579.

DOI:10.2196/59579

PMID:39965802

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12022529/

Abstract

BACKGROUND

Type 1 diabetes mellitus (T1DM) significantly affects patients' quality of life and can be life-threatening, necessitating improved monitoring strategies. Telemedicine, which leverages telecommunications technologies to deliver health care services and expertise, has the potential to enhance T1DM management. However, its effectiveness remains to be fully established.

OBJECTIVE

This study aims to evaluate the effectiveness of various telemedicine-based carbohydrate-counting (CC) interventions in patients with T1DM.

METHODS

This systematic review and meta-analysis searched 5 databases-PubMed, Web of Science, CINAHL, Embase, and Cochrane-as well as reference lists of retrieved articles on September 26, 2024, for randomized controlled trials (RCTs) assessing the effectiveness of telemedicine-based CC interventions in reducing glycated hemoglobin A (HbA) levels in patients with T1DM.

RESULTS

From 3612 citations, we identified 18 eligible RCTs (n=1627) from 14 regions for inclusion in the meta-analysis. Participants in the telemedicine intervention group experienced a 0.35% reduction in HbA levels (95% CI -0.54 to -0.16) compared with the control group. A total of 13 studies used smartphone apps, 4 used connected and wearable glucometers, and 3 delivered the intervention through web-based systems. Significant reductions in HbA were observed across smartphone apps (-0.36%, 95% CI -0.63% to -0.09%), connected and wearable glucometers (-0.35%, 95% CI -0.56% to -0.14%), and web-based systems (-0.36%, 95% CI -0.71% to -0.02%). Considerable heterogeneity was noted (I2=81%, P<.001). Telemedicine-based CC interventions also increased time in range by 9.59% (95% CI 6.50%-12.67%). However, evidence regarding treatment satisfaction, total daily insulin dose, and hypoglycemia remains inconclusive. Subgroup analysis showed that telemedicine platform variety did not significantly contribute to heterogeneity, while meta-regression indicated that the impact on HbA was most pronounced in trials conducted in Asia.

CONCLUSIONS

Compared with usual care, telemedicine-delivered CC interventions improved HbA and time in range but did not significantly impact other clinically relevant outcomes in patients with T1DM. High-quality, large-scale RCTs are needed to draw definitive conclusions. These findings provide health care professionals with updated evidence on the role of telemedicine in glycemic control for patients with T1DM.

TRIAL REGISTRATION

PROSPERO CRD42024523025; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024523025.

摘要

背景

1型糖尿病（T1DM）严重影响患者的生活质量，甚至可能危及生命，因此需要改进监测策略。远程医疗利用电信技术提供医疗服务和专业知识，有潜力加强T1DM的管理。然而，其有效性仍有待充分确立。

目的

本研究旨在评估各种基于远程医疗的碳水化合物计数（CC）干预措施对T1DM患者的有效性。

方法

本系统评价和荟萃分析于2024年9月26日检索了5个数据库——PubMed、科学网、护理学与健康领域数据库、Embase和考克兰图书馆——以及检索到的文章的参考文献列表，以查找评估基于远程医疗的CC干预措施在降低T1DM患者糖化血红蛋白A（HbA）水平方面有效性的随机对照试验（RCT）。

结果

从3612篇文献中，我们确定了来自14个地区的18项符合条件的RCT（n = 1627）纳入荟萃分析。与对照组相比，远程医疗干预组的HbA水平降低了0.35%（95%CI -0.54至-0.16）。共有13项研究使用了智能手机应用程序，4项使用了联网和可穿戴血糖仪，3项通过基于网络的系统提供干预。在智能手机应用程序（-0.36%，95%CI -0.63%至-0.09%）、联网和可穿戴血糖仪（-0.35%，95%CI -0.56%至-0.14%）以及基于网络的系统（-0.36%，95%CI -0.71%至-0.02%）中均观察到HbA显著降低。观察到相当大的异质性（I² = 81%，P <.001）。基于远程医疗的CC干预措施还使血糖达标时间增加了9.59%（95%CI 6.50% - 12.67%）。然而，关于治疗满意度、每日胰岛素总剂量和低血糖的证据仍然不确定。亚组分析表明，远程医疗平台的多样性对异质性没有显著影响，而荟萃回归表明，在亚洲进行的试验中对HbA的影响最为明显。