The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis of systematic reviews of randomised controlled trials.
The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis of systematic reviews of randomised controlled trials.
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DOI：
10.1186/s12913-018-3274-8
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发表时间：
2018-06-26
影响因子：
2.8
通讯作者：
Pappas Y
中科院分区：
文献类型：
--
作者：
Lee PA;Greenfield G;Pappas Y
越来越多的证据支持使用远程医疗来监测2型糖尿病患者的HbA 1c水平。然而，由于现有系统性综述中报告的结果不同，因此总体影响程度尚不清楚。本研究的目的是对随机对照试验的系统评价进行系统评价和荟萃分析，为远程医疗干预对2型糖尿病成人血糖控制的有效性建立证据基础。检索了电子数据库，包括科克伦图书馆、MEDLINE、EMBASE、HMIC和PsychINFO，以识别1990年至2016年4月期间发表的相关系统性综述，并补充了相关综述的参考文献检索。两名独立评审员选择并评审了符合条件的研究。在检索到的3279篇参考文献中，纳入了4篇系统性综述，共报告了29项与我们综述相关的独特研究。进行了传统的成对荟萃分析和网络荟萃分析。来自汇集四项系统性综述的证据发现，与常规护理相比，远程医疗干预措施对HbA 1c水平产生了微小但显著的改善（MD：-0.55，95%CI：-0.73至-0.36）。最大的影响是在电话提供的干预措施，其次是互联网血糖监测系统的干预措施，最后是干预措施，涉及自动传输SMBG使用移动的电话或远程医疗单位。目前的证据表明，远程医疗在控制2型糖尿病患者的HbA 1c水平方面是有效的。然而，需要更高质量的初步研究以及随机对照试验的系统评价，以便自信地得出远程医疗对2型糖尿病血糖控制的影响的结论。本文的在线版本（10.1186/s12913-018-3274-8）包含补充材料，可供授权用户使用。
There is a growing body of evidence to support the use of telehealth in monitoring HbA1c levels in people living with type 2 diabetes. However, the overall magnitude of effect is yet unclear due to variable results reported in existing systematic reviews. The objective of this study is to conduct a systematic review and meta-analysis of systematic reviews of randomised controlled trials to create an evidence-base for the effectiveness of telehealth interventions on glycemic control in adults with type 2 diabetes. Electronic databases including The Cochrane Library, MEDLINE, EMBASE, HMIC, and PsychINFO were searched to identify relevant systematic reviews published between 1990 and April 2016, supplemented by references search from the relevant reviews. Two independent reviewers selected and reviewed the eligible studies. Of the 3279 references retrieved, 4 systematic reviews reporting in total 29 unique studies relevant to our review were included. Both conventional pairwise meta-analyses and network meta-analyses were performed. Evidence from pooling four systematic reviews found that telehealth interventions produced a small but significant improvement in HbA1c levels compared with usual care (MD: -0.55, 95% CI: -0.73 to − 0.36). The greatest effect was seen in telephone-delivered interventions, followed by Internet blood glucose monitoring system interventions and lastly interventions involving automatic transmission of SMBG using a mobile phone or a telehealth unit. Current evidence suggests that telehealth is effective in controlling HbA1c levels in people living with type 2 diabetes. However there is need for better quality primary studies as well as systematic reviews of RCTs in order to confidently conclude on the impact of telehealth on glycemic control in type 2 diabetes. The online version of this article (10.1186/s12913-018-3274-8) contains supplementary material, which is available to authorized users.
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