Online Program

329199
Does Telemedicine Improve Treatment Outcomes for Diabetes? A Systematic Review and Meta-Analysis of Results from 38 Studies


Tuesday, November 3, 2015

Dejun Su, PhD, Department of Health promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, NE
Megan Kelley, MS, CHES, Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE
Junmin Zhou, Department of Health Promotion, Social & Behavioral Health, University of Nebraska Medical Center, Omaha, NE
Background. A growing number of studies have documented the impact of telemedicine on diabetes management. Limited systematic reviews have failed to yield consistent and convincing results due to modest sample sizes, lack of standardized methodology for meta-analysis, and/or inadequate attention to risks of bias.

Objectives.

1) To apply PRISMA guidelines in conducting a meta-analysis study on the impact of telemedicine in the management of diabetes;

2) To examine and interpret the results, both overall and stratified by subgroups;

3) To assess the robustness of findings by looking into the risks of bias within and across studies.

Methods.  A literature search identified randomized controlled trials examining the effect of telemedicine interventions on HbA1c levels in patients with Type 1 or Type 2 diabetes published until August 8, 2014. The search terms used were “telehealth,” “telemedicine,” and “diabetes.”  Thirty-eight studies were retained for analysis. The meta-analysis was performed using the Comprehensive Meta-Analysis v2 software program to compute Hedges’s g as the summary measure of mean change in HbA1c across studies using a random effects model. We examined overall results as well as stratified results by type of diabetes (Type 1 or 2), age group (younger than 40, 40 to younger than 60, 60 and older), duration of study (6 months or less, more than 6 months), and intervention level (remote monitoring or teleconsultation).

Results. Overall, the results of this meta-analysis favor telemedicine intervention compared to usual care (Hedges’s g= -0.44, SE= 0.09, p<0.001). Subgroup analysis reveals that the effect of telemedicine differs by all subgroups. In particular, teleconsultation appears to be a more effective approach than remote monitoring.

Discussion/Conclusion. Telemedicine is generally effective in improving treatment outcomes for diabetes. Despite its technological advantages relative to teleconsultation, the lack of corresponding effectiveness of remote monitoring in improving diabetes treatment outcomes warrants further research.

Learning Areas:

Administer health education strategies, interventions and programs
Communication and informatics
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
Assess the impact of telemedicine on diabetes management through a systematic review and meta-analysis of 38 selected studies based on the PRISMA guidelines (http://www.prisma-statement.org); Evaluate the robustness of meta-analysis findings by looking into risks of bias within and across studies.

Keyword(s): Telehealth, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have eight years of progressive analytical public health research experience on chronic diseases (e.g. hypertension, diabetes, and heart disease). Specifically, I have been designing and conducting quantitative researches on chronic diseases using large national data-sets for a long period.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.