Effectiveness of Telemedicine in Managing Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

Abstract

Background: Strict monitoring of blood glucose during pregnancy is essential for ensuring optimal maternal and neonatal outcomes. Telemedicine could be a promising solution for supporting diabetes management; however, an updated meta-analysis is warranted. This study assesses the effects of telemedicine solutions for managing gestational and pregestational diabetes. Methods: PubMed, EMBASE, Cochrane Library Central Register of Controlled Trials, and CINAHL were searched up to October 14, 2020. All randomized trials assessing the effects of telemedicine in managing diabetes in pregnancy relative to any comparator without the use of telemedicine were included. The primary outcome was infant birth weight. A meta-analysis comparing the mean difference (MD) in birth weight across studies was applied, and subgroup and sensitivity analyses were performed. The revised Cochrane tool was applied to assess the risk of bias, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: From a total of 18 studies, ten (totaling 899 participants) were used to calculate the effect on infant birth weight. The results nonsignificantly favored the control (MD of 19.34 g; [95% confidence interval, CI −47.8; 86.47]), with moderate effect certainty. Heterogeneity was moderate ( I2 = 37.39%). Statistically significant secondary outcomes included differences in two-hour glucose tolerance postpartum (gestational diabetes; two studies: standardized mean difference 9.62 mg/dL [95% CI: 1.95; 17.28]) that favored the control (GRADE level, very low) and risk of shoulder dystocia (four studies: log odds −1.34 [95% CI: −2.61; −0.08]) that favored telemedicine (GRADE, low). Conclusions: No evidence was found to support telemedicine as an alternative to usual care when considering maternal and fetal outcomes. However, further research is needed, including economic evaluations.

Glycaemic control and novel technology management strategies in pregestational diabetes mellitus

“…Telemedicine offers increased convenience and flexibility and is generally acceptable to patients however to be beneficial in PGDM hard outcomes like glycaemic control and fetal outcomes need to be evaluated ( 107 ). A systematic review of the use of telemedicine in treating both PGDM and gestational diabetes (GDM) did not find any benefit in maternal or fetal outcomes, although very few studies evaluated women with PGDM ( 108 ). In studies that did include small numbers of patients with PGDM, telemedicine resulted in fewer GP and nurse visits ( 109 ), improved satisfaction and quality of life ( 110 ) and some slight improvements in glycaemic control ( 111 ).…”

Management of type 2 diabetes in pregnancy: a narrative review

“…However, a recent meta-analysis showed no improvement of maternal and fetal outcomes when using telemedicine compared to usual care. Further research is needed, including economic evaluations (59). A good example of a helpful app is 'Pregnant with Diabetes', developed by Danish researchers which gives evidence-based clinical recommendations and was launched in 2014 (60).…”