Mapping the Evidence on the Effectiveness of Telemedicine Interventions in Diabetes, Dyslipidemia, and Hypertension: An Umbrella Review of Systematic Reviews and Meta-Analyses

Abstract

Background Telemedicine is defined by three characteristics: (1) using information and communication technologies, (2) covering a geographical distance, and (3) involving professionals who deliver care directly to a patient or a group of patients. It is said to improve chronic care management and self-management in patients with chronic diseases. However, currently available guidelines for the care of patients with diabetes, hypertension, or dyslipidemia do not include evidence-based guidance on which components of telemedicine are most effective for which patient populations. Objective The primary aim of this study was to identify, synthesize, and critically appraise evidence on the effectiveness of telemedicine solutions and their components on clinical outcomes in patients with diabetes, hypertension, or dyslipidemia. Methods We conducted an umbrella review of high-level evidence, including systematic reviews and meta-analyses of randomized controlled trials. On the basis of predefined eligibility criteria, extensive automated and manual searches of the databases PubMed, EMBASE, and Cochrane Library were conducted. Two authors independently screened the studies, extracted data, and carried out the quality assessments. Extracted data were presented according to intervention components and patient characteristics using defined thresholds of clinical relevance. Overall certainty of outcomes was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Results Overall, 3564 references were identified, of which 46 records were included after applying eligibility criteria. The majority of included studies were published after 2015. Significant and clinically relevant reduction rates for glycated hemoglobin (HbA1c; ≤−0.5%) were found in patients with diabetes. Higher reduction rates were found for recently diagnosed patients and those with higher baseline HbA1c (>8%). Telemedicine was not found to have a significant and clinically meaningful impact on blood pressure. Only reviews or meta-analyses reporting lipid outcomes in patients with diabetes were found. GRADE assessment revealed that the overall quality of the evidence was low to very low. Conclusions The results of this umbrella review indicate that telemedicine has the potential to improve clinical outcomes in patients with diabetes. Although subgroup-specific effectiveness rates favoring certain intervention and population characteristics were found, the low GRADE ratings indicate that evidence can be considered as limited. Future updates of clinical care and practice guidelines should carefully assess the methodological quality of studies and the overall certainty of subgroup-specific outcomes before recommending telemedicine interventions for certain patient populations.

Telemedicine for diabetes care in India during COVID19 pandemic and national lockdown period: Guidelines for physicians

“…There was overall mean reduction in HbA1c in telemedicine intervention group in both T1DM (-0.12 to -0.86%) and T2DM (-0.01% to -1.13%) patients. 13 Research on telemedicine and diabetes in India is sparse. In a recently published article from our group, we have shown usage of customized mobile van with facility of telemedicine (use of computer and Skype video app to transmit retinal images to ophthalmologist and to consult with diabetes foot specialist and diabetologist at a tertiary care center) in underprivileged areas of Delhi.…”

Diabetes care during COVID-19 lockdown at a tertiary care centre in India

“…Although we could not assess overall efficacy of telemedicine consultation for diabetes care in terms of improvement in glycaemic, blood pressure or lipid targets in this preliminary report, a meta-analysis of 35 RCT's has shown a significant beneficial effect of using telemedicine in improving glycaemic control [8]. Similar results have also been demonstrated in a Cochrane review with use of interactive telemedicine, and another review of 46 studies where different modes of telemedicine were used [9,10]. When it comes to India, there is hardly any published research on telemedicine for diabetes care.…”

Research Implications for Future Telemedicine Studies and Innovations in Diabetes and Hypertension—A Mixed Methods Study

“…Our results show that many study groups criticize the presence of small pilot studies and limited data on mid-to long-term outcomes. This was also a result of the assessment of publication bias in the included studies analyzed in the previous umbrella review [14], highlighting a dominance of smaller studies with larger effect sizes. Some of the included records also criticize inadequate reporting of study data, which is also attributed to an inadequacy of existing reporting guidelines [40,45,48].…”

“…An update of a recently published umbrella review was conducted to identify relevant literature [14]. As such, systematic reviews or meta-analyses of RCTs evaluating the effectiveness of telemedicine in at least one of the target diseases (diabetes, hypertension and/or dyslipidemia) in adults were searched again in the databases Pubmed, Embase, and the Cochrane Library.…”

“…Additionally, a comparison of study results in order to provide evidence-based recommendations is further complicated by the diversity of applied study designs [12,13] and the heterogeneous definitions of "telemedicine" [1]. Consequently, a recent umbrella review conducted by the authors indicates that although telemedicine was found to potentially improve clinical outcomes in patients with diabetes or hypertension, the methodological quality of studies and overall certainty of subgroup-specific effectiveness were considered as moderate to low [14].…”