Telemedicine for the Management of Glycemic Control and Clinical Outcomes of Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.
Telemedicine for the Management of Glycemic Control and Clinical Outcomes of Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.
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DOI：
10.3389/fphar.2017.00330
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发表时间：
2017
影响因子：
5.6
通讯作者：
Lai YK
中科院分区：
文献类型：
--
作者：
Lee SWH;Ooi L;Lai YK
重要性：远程医疗已被证明是一种为慢性病患者提供护理的高效且有效的手段，特别是在偏远和不发达地区，可以改善护理机会并降低医疗成本。然而，围绕其在 1 型糖尿病中的适用性的证据仍然很少且相互矛盾。目的：相对于对照条件，综合证据并量化远程医疗干预措施对 1 型糖尿病患者血糖和临床结果管理的有效性。数据来源：对 MEDLINE、EMBASE、Cochrane Library、Web of Science、PsycINFO 和 CINAHL 进行搜索，查找自成立以来直至 2016 年 12 月发表的文章。研究选择：纳入了报告远程医疗对 1 型糖尿病患者有效性的随机对照研究结果的原始文章。数据提取和综合：两名评审员独立提取数据，评估质量和证据强度。干预措施根据远程医疗重点（监测、教育、咨询、病例管理和同伴指导）进行分类。主要结果和测量：糖化血红蛋白 A1c (HbA1c) 从基线到后续评估的绝对变化。结果：共确定了 41 篇文章中描述的 38 项研究。远程医疗研究发现对血糖控制有积极作用，干预结束时血糖平均降低 0.18%。招募基线 HbA1c (≥9%) 较高的患者的持续时间较长（>6 个月）的研究与较大的效应相关。涉及个性化评估、反馈审核和技能培养的远程医疗干预措施在改善血糖控制方面也更有效。然而，在血压、血脂、体重、生活质量和不良事件方面没有观察到任何益处。结论和相关性：没有足够的证据支持远程医疗用于 1 型糖尿病患者的血糖控制和其他临床相关结果。
Importance: Telemedicine has been shown to be an efficient and effective means of providing care to patients with chronic disease especially in remote and undeserved regions, by improving access to care and reduce healthcare cost. However, the evidence surrounding its applicability in type 1 diabetes remains scarce and conflicting. Objective: To synthesize evidence and quantify the effectiveness of telemedicine interventions for the management of glycemic and clinical outcomes in type 1 diabetes patients, relative to comparator conditions. Data Sources: MEDLINE, EMBASE, Cochrane Library, Web of Science, PsycINFO, and CINAHL were searched for published articles since inception until December 2016. Study Selection: Original articles reporting the results of randomized controlled studies on the effectiveness of telemedicine in people with type 1 diabetes were included. Data Extraction and Synthesis: Two reviewers independently extracted data, assessed quality, and strength of evidence. Interventions were categorized based upon the telemedicine focus (monitoring, education, consultation, case-management, and peer mentoring). Main Outcome and Measure: Absolute change in glycosylated hemoglobin A1c (HbA1c) from baseline to follow-up assessment. Results: A total of 38 studies described in 41 articles were identified. Positive effects on glycemic control were noted with studies examining telemedicine, with a mean reduction of 0.18% at the end of intervention. Studies with longer duration (>6 months) who had recruited patients with a higher baseline HbA1c (≥9%) were associated with larger effects. Telemedicine interventions that involve individualized assessments, audit with feedback and skill building were also more effective in improving glycemic control. However, no benefits were observed on blood pressure, lipids, weight, quality of life, and adverse events. Conclusions and Relevance: There is insufficient evidence to support telemedicine use for glycemic control and other clinically relevant outcome among patients with type 1 diabetes.