MANAGEMENT OF ENDOCRINE DISEASE: Effects of telecare intervention for glycemic control in Type 2 Diabetes: A systematic review and meta-analysis of randomized controlled trials.
Objective: To review published literature on the effects of telecare intervention in patients with Type 2 Diabetes and inadequate glycemic control. Design and methods: A review of randomized controlled trials (RCTs) on telecare intervention in patients with type 2 diabetes, and a search of electronic databases such as The Cochrane Library, PubMed, EBSCO, CINAHL, Science Direct, Journal of Telemedicine and Telecare, and China National Knowledge Infrastructure (CNKI), were conducted from December 8-16, 2013. Two evaluators independently selected and reviewed the eligible studies. Change in glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), Body Mass Index (BMI), and body weight were analyzed. Results: An analysis of 18 studies with 3,798 subjects revealed that telecare significantly improved the management of diabetes. Mean HbA1c values reduced by (-0.54; 95% confidence interval [CI], -0.75 to -0.34; P < 0.05), mean FPG levels by (-9.00 mg/dL; 95% CI, -17.36 to -0.64; P = 0.03), and mean PPG levels reduced by (-52.86 mg/dL; 95% CI, -77.13 to -28.58; P < 0.05) than the group receiving standard care. Meta-regression and subgroup analyses showed that study location, sample size, and treatment monitoring techniques were sources of heterogeneity. Conclusions: Patients monitored by telecare showed significant improvement in glycemic control in type 2 diabetes than those monitored by routine follow-up. Significant reduction in HbA1c was associated with Asian populations, small sample size, and telecare, and those with patients with baseline HbA1c greater than 8.0%.