Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials

Su, Dejun; Zhou, Jiming; Kelley, Megan; Michaud, Tzeyu L.; Siahpush, Mohammad; Kim, Jungyoon; Wilson, Fernando A.; Stimpson, Jim P.; Pagán, José A.

doi:10.1016/j.diabres.2016.04.019

Cited by 142 publications

(106 citation statements)

References 62 publications

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confidence: 78%

“…These findings indicate that improvement in glycemic control for the telemedicine patients was similar to that of patients at an academic medical center. This is consistent with a meta-analysis that showed telemedicine compared favorably to face-to-face care for patients with diabetes [4].The interdisciplinary telemedicine diabetes team was both well received by patients and effective at improving patient outcomes comparable to an academic medical center. The pharmacist was an integral part of the team by assessing patient needs, providing education, and developing strategies to improve adherence.…”

supporting

confidence: 75%

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A Clinical Pharmacist in Telehealth Team Care for Rural Patients with Diabetes

Nye

2017

North Carolina Medical Journal

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The prevalence of diabetes in eastern North Carolina is higher than the state average (12.8% vs. 10.3%) [1]. The American Diabetes Association and the chronic care model recommend using a team-based approach to optimize care for patients with diabetes [2,3]. However, primary care clinics in rural areas often do not have the patient demand or resources to have interprofessional teams on site. Telemedicine can bring interprofessional team-based care to patients in rural health care practices by utilizing remote electronic communication.From 2013-2016, a diabetes telemedicine program funded by the Health Resources & Services Administration and Kate B. Reynolds Charitable Trust was offered in 13 sites in eastern North Carolina, including federally funded Community Health Clinics. A telemedicine team offered interdisciplinary care in the primary care provider's (PCP's) office without the patient needing to travel. The interdisciplinary team included a clinical pharmacist, dietician, behavioral therapist, and physician specializing in diabetes. The PCP referred the patient to 1 or more disciplines depending on the patient's needs. The program targeted underserved rural adults with uncontrolled type 2 diabetes. Patients were frequently challenged by comorbid distress, depression, behavioral/lifestyle challenges, finances, and limited local care. More than 70% of patients had incomes at or below 200% of the federal poverty level.The interdisciplinary team included 3 part-time pharmacists. At each patient's first appointment the pharmacist took a medication history. Then he/she assessed adherence, knowledge of medications for diabetes, and injection technique. The pharmacist reviewed the patients' blood glucose logs to identify trends and provide feedback to the patients, and then helped them understand how taking their medications affects their individual glucose results.After the assessment, the pharmacist provided education to fill in the gaps in each patient's understanding. Topics could include general diabetes education, selfmanagement, and counseling on their specific medications. If patients had difficulty taking their medication or checking blood glucose as recommended, the pharmacist identified barriers and offered individualized strategies to improve adherence. The pharmacist recommended changes in prescription medications to the PCP. The most common recommendations were selection of a new medication and changes to the dose of insulin.As part of the interdisciplinary team, the pharmacist checked on patient progress following lifestyle recommendations made by other members of the team. These recommendations were documented and members from other disciplines were alerted if there were concerns. In addition, the pharmacist identified problems that should be addressed by nutrition or behavioral medicine and suggested a referral from the PCP when needed.Appointments for members of the interdisciplinary team were scheduled with the patient's PCP or another telehealth provider if possible. This made attending the NCM...

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supporting

confidence: 78%

supporting

confidence: 75%

A Clinical Pharmacist in Telehealth Team Care for Rural Patients with Diabetes

Nye

2017

North Carolina Medical Journal

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“…A recent meta-analysis of 55 randomized controlled trials found that telemedicine provided a larger reduction in HbA 1c than traditional treatment programs and was particularly effective for T2D versus T1D [18]. Despite the effectiveness in adult populations, none of the 55 studies included pediatric patients with T2D.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Loss to Follow-Up among Children with Type 2 Diabetes

et al. 2017

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Background/Aims: Youth with type 2 diabetes (T2D) have poor compliance with medical care. This study aimed to determine which demographic and clinical factors differ between youth with T2D who receive care in a pediatric diabetes center versus youth lost to follow-up for >18 months. Methods: Data were analyzed from 496 subjects in the Pediatric Diabetes Consortium registry. Enrollment variables were selected a priori and analyzed with univariable and multivariable logistic regression models. Results: After a median of 1.3 years from enrollment, 55% of patients were lost to follow-up. The final model included age, race/ethnicity, parent education, and estimated distance to study site. The odds ratio (99% confidence interval) of loss to follow-up was 2.87 (1.34, 6.16) for those aged 15 to <18 years versus those aged 10 to <13 years and 6.57 (2.67, 16.15) for those aged ≥18 years versus those aged 10 to <13 years. Among patients living more than 50 miles from the clinic, the odds ra tio of loss to follow-up was 3.11 (1.14, 8.49) versus those living within 5 miles of the site. Conclusion: Older adolescents with T2D are more likely to be lost to follow-up, but other socioeconomic factors were not significant predictors of clinic follow-up.

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“…A large number of studies in a wide range of disciplines have bid to document the telemedicine effectiveness. It has been found that telemedicine is effective in the management of adult malnutrition [11]; asthma [12]; heart disease [13], diabetes-especially type 2 [14]; arterial hypertension [15] and multiple sclerosis [16]. In addition, positive clinical results have been presented for the patient followup and treatment in different situations such as: (1) burned [17]; (2) in palliative care [18]; (3) with acute cerebrovascular accident [19]; (4) with mental disorders [20]; (5) geriatric [21]; and (6) newborns, children and adolescents [22,23].…”

Section: Telemedicinementioning

confidence: 99%

Toward a Design of a Telerehabilitation Program for the Functional Recovery in Post-Hip Arthroplasty Patients

Esparza¹,

Aladro-Gonzalvo²,

Baldeón³

et al. 2019

Assistive and Rehabilitation Engineering

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Telerehabilitation uses new information and communication technologies as an instrument to ensure a distant rehabilitation service. Patients who underwent hip replacement surgery are an excellent case study for the application of this technology. Post-surgical rehabilitation guidelines for hip arthroplasty are well known, and the correct application has a positive effect on the patients' prognosis. However, there are no complementary guidelines for physical therapy that could be used at a distance by patients through a computer platform. This chapter presents a systematic review about conventional physical therapy programs for hip arthroplasty. Based on this review, we proposed therapeutic exercises adapted to a low cost web-platform. In order to reach this objective we will present a brief review of the total hip arthroplasty, telemedicine, telerehabilitation and conventional physical therapy approaches.

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Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials

Cited by 142 publications

References 62 publications

A Clinical Pharmacist in Telehealth Team Care for Rural Patients with Diabetes

A Clinical Pharmacist in Telehealth Team Care for Rural Patients with Diabetes

Predictors of Loss to Follow-Up among Children with Type 2 Diabetes

Toward a Design of a Telerehabilitation Program for the Functional Recovery in Post-Hip Arthroplasty Patients

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