Telemedicine application in the care of diabetes patients: systematic review and meta-analysis.
Telemedicine application in the care of diabetes patients: systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0079246
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Ribeiro AL
中科院分区：
文献类型：
--
作者：
Marcolino MS;Maia JX;Alkmim MB;Boersma E;Ribeiro AL
远程医疗应用对糖尿病患者管理的影响尚不清楚，因为不同研究的结果并不一致。本研究的目的是对评估远程医疗干预对糖尿病患者血红蛋白A1 c（HbA 1c）、血压、低密度脂蛋白胆固醇（LDL-c）和体重指数（BMI）变化的影响的随机对照试验（RCT）进行系统综述和荟萃分析。检索电子数据库MEDLINE、科克伦对照试验中心注册中心和LILACS，以确定截至2012年4月发表的相关研究，并补充所选文章的参考文献。研究检索和选择由独立评审员进行。在检索到的6.258篇文章中，纳入了13项RCT（4207例患者）。采用随机效应模型估计合并结果。与对照组相比，远程医疗与HbA 1c水平的统计学显著和临床相关绝对下降相关（平均差异为-0.44% [-4.8 mmol/mol]，95%置信区间[CI]为-0.61至-0.26% [-6.7至-2.8 mmol/mol]; p<0.001）。LDL-c降低6.6 mg/dL（95% CI -8.3至-4.9; p<0.001），但该效应的临床相关性值得怀疑。未观察到远程医疗策略对收缩压（-1.6 mmHg和95% CI -7.2至4.1）和舒张压（-1.1 mmHg和95% CI -3.0至0.8）的影响。评估对BMI影响的2项研究表明，BMI降低的趋势有利于远程医疗。远程医疗策略与常规护理相结合，可改善糖尿病患者的血糖控制。未观察到对LDL-c和血压的临床相关影响，使用远程医疗的糖尿病患者有BMI降低的趋势，但这些结果应在未来的试验中进一步探讨。
The impact of telemedicine application on the management of diabetes patients is unclear, as the results are not consistent among different studies. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of telemedicine interventions on change in hemoglobin A1c (HbA1c), blood pressure, LDL cholesterol (LDL-c) and body mass index (BMI) in diabetes patients. Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched to identify relevant studies published until April 2012, supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Of the 6.258 articles retrieved, 13 RCTs (4207 patients) were included. Random effects model was applied to estimate the pooled results. Telemedicine was associated with a statistically significant and clinically relevant absolute decline in HbA1c level compared to control (mean difference -0.44% [-4.8 mmol/mol] and 95% confidence interval [CI] -0.61 to -0.26% [-6.7 to -2.8 mmol/mol]; p<0.001). LDL-c was reduced in 6.6 mg/dL (95% CI -8.3 to -4.9; p<0.001), but the clinical relevance of this effect can be questioned. No effects of telemedicine strategies were seen on systolic (-1.6 mmHg and 95% CI -7.2 to 4.1) and diastolic blood pressure (-1.1 mmHg and 95% CI -3.0 to 0.8). The 2 studies that assessed the effect on BMI demonstrated a tendency of BMI reduction in favor of telemedicine. Telemedicine strategies combined to the usual care were associated with improved glycemic control in diabetic patients. No clinical relevant impact was observed on LDL-c and blood pressure, and there was a tendency of BMI reduction in diabetes patients who used telemedicine, but these outcomes should be further explored in future trials.
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影响因子：
15.8
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
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