Jorge César Correia1, Hafsa Meraj2, Soo Huat Teoh3, Ahmed Waqas4, Maaz Ahmad5, Luis Velez Lapão6, Zoltan Pataky1, Alain Golay1. 1. Department of Medicine, Geneva University Hospitals, Chemin Venel 7, 1206 Geneva, Switzerland. 2. Faculty of Life Sciences and Education, University of South Wales, Pontypridd, Wales. 3. Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia. 4. Institute of Population Health, University of Liverpool, Liverpool, England. 5. Department of Oral Biology, Sharif Medical and Dental College, Lahore, Pakistan. 6. Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.
Abstract
OBJECTIVE: To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. METHODS: 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. FINDINGS: 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; I 2 = 86.70%), -0.20 for fasting blood sugar (95% CI: -0.32 to -0.08; I 2 = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I 2 = 93.75%), 0.55 for diabetes knowledge (95% CI: -0.10 to 1.20; I 2 = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I 2 = 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; I 2 = 35.94%), -0.06 for total cholesterol (95% CI: -0.16 to 0.04; I 2 = 59.93%) and -0.02 for triglycerides (95% CI: -0.12 to 0.09; I 2 = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications. CONCLUSION: 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. (c) 2021 The authors; licensee World Health Organization.
OBJECTIVE: To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. METHODS: 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. FINDINGS: 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; I 2 = 86.70%), -0.20 for fasting blood sugar (95% CI: -0.32 to -0.08; I 2 = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I 2 = 93.75%), 0.55 for diabetes knowledge (95% CI: -0.10 to 1.20; I 2 = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I 2 = 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; I 2 = 35.94%), -0.06 for total cholesterol (95% CI: -0.16 to 0.04; I 2 = 59.93%) and -0.02 for triglycerides (95% CI: -0.12 to 0.09; I 2 = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications. CONCLUSION: 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. (c) 2021 The authors; licensee World Health Organization.
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