Meta-analysis of telemonitoring to improve HbA1c levels: Promise for stroke survivors

Lieber, Bryan; Taylor, Brittany L.; Appelboom, Geoff; Prasad, Kiran; Bruce, Sam; Yang, Annie; Bruce, Eliza; Christophe, Brandon R.; Connolly, E. Sander

doi:10.1016/j.jocn.2014.11.009

Cited by 22 publications

(28 citation statements)

References 41 publications

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“…Multimedia Appendix 4 gives scores for the individual components of the R-AMSTAR score. Taking into account quality assessment, explicit self-management focus, and total population size, 8 reviews received an evidence weighting of 3 stars [16,21,25,26,38,45,53,56], 23 received 2 stars [22,24,27-31, 33,37,40,42,44,46,49,50,52,54,55,58,62,63,67,68], 21 received 1 star [19,20,23,32,34-36,39,43,47,48,51,57, 59-61,64-66,69,70], and 1 received no stars [41]. The first column of the table in Multimedia Appendix 5 displays these criteria.…”

Section: Resultsmentioning

confidence: 99%

“…Narrative syntheses showed mixed results, with modest benefit in telehealth interventions both in place of and supplementing usual care [37], little evidence of benefit from telehealth interventions that excluded telephone support [28], and positive results for telehealth-delivered behavioral interventions (n=13 RCTs) [22]. Three 1-star narrative syntheses suggested improved outcomes with mobile phone interventions [32,35,36], but others showed no overall benefit from teleconsultations [47,51] or telemonitoring [34,39]. …”

Section: Resultsmentioning

confidence: 99%

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Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer

Hanlon¹,

Daines²,

Campbell³

et al. 2017

J Med Internet Res

465

354

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BackgroundSelf-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions.ObjectiveThe objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support.MethodsWe performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots.ResultsWe included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma.ConclusionsWhile telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer

Hanlon¹,

Daines²,

Campbell³

et al. 2017

J Med Internet Res

465

354

View full text Add to dashboard Cite

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“…Fig. 2 The 5-year survival curve of elderly patients with diabetes based on the BMI score Table 2 The Cox regression analysis for the indices that influence the survival rate of elderly patients with diabetes Since the control of diabetes can reduce the risk of brain stroke and even decrease the risk of mortality in individuals who developed brain stroke [29], such patients should be the main focus. In addition, the role of BMI and muscular strength in the rehabilitation of elderly patients with diabetes and brain stroke and the reduction of mortality rate in such patients should be further investigated.…”

Section: Discussionmentioning

confidence: 99%

Obesity paradox on the survival of elderly patients with diabetes: an AHAP-based study

Bijani

Cumming

Hosseini

et al. 2018

J Diabetes Metab Disord

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Background and objectives Overweight and obesity are among the important challenges in health issues and survival of elderly people. The current study aimed to evaluate the survival rate of elderly patients with diabetes, and its influencing factors, on the basis of body mass index (BMI). Methods and materialsThe design of the current study was based on the Amirkola Health and Aging Project (AHAP) cohort.The 5-year survival rate of elderly people with diabetes and the factors that influence the mortality rate by Cox regression model were analyzed. Results Out of 1616 elderly people who were evaluated in the current study, 501 (31%) had diabetes. The results showed that diabetes significantly increased the mortality rate (adjusted hazard ratio [HR] = 2.10; 95% confidence interval [CI]: 1.57-2.81; P < 0.001). Furthermore, overweight (HR = 0.41; 95%CI: 0.24-0.75; P = 0.002), obesity (HR = 0.30; 95% CI: 0.41-0.63; P = 0.002), history of diabetes (HR = 0.56; 95%CI: 0.34-0.93; P = 0.024), moderate and high physical activity level (HR = 0.36; 95%CI: 0.13-0.99; P = 0.049) decreased the risk of mortality and central obesity (HR = 1.76; 95% CI: 1.01-3.11; P = 0.049), fasting blood sugar ≥200 (HR = 2.46; 95% CI: 1.46-4.15; P < 0.001), brain stroke, and neurological diseases (HR = 3.12; 95% CI: 1.78-5.49; P < 0.001) increased the risk of mortality. Conclusion Although overweight and obesity significantly improved the risk of mortality in elderly patients with diabetes, central obesity is still considered as an important risk factor.

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“…Some did not distinguish results for type 1 or type 2 diabetes [ 21 •, 22 , 23 , 31 – 33 ]. Some exclusively examined one single type of HITs [ 21 •, 33 – 36 ] or specified study’s searching criteria to a particular patient population [ 27 , 37 ]. The objective of the present study was to systematically review and examine the current state of evidence concerning the effects of HITs on patient outcomes, particularly on glycemic control among patients with type 2 diabetes.…”

Section: Introductionmentioning

confidence: 99%

Effect of Health Information Technologies on Glycemic Control Among Patients with Type 2 Diabetes

et al. 2018

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Purpose of ReviewThis study was to present meta-analysis findings across selected clinical trials for the effect of health information technologies (HITs) on glycemic control among patients with type 2 diabetes.Recent FindingsHITs may be promising in diabetes management. However, findings on effect size of glycated hemoglobin level (HbA1c) yielded from HITs varied across previous studies. This is likely due to heterogeneity in sample size, adherence to standard quantitative method, and/or searching criteria (e.g., type of HITs, type of diabetes, specification of patient population, randomized vs. nonrandomized trials).SummaryWe systematically searched Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and the Cochrane Library for peer-reviewed randomized control trials that studied the effect of HITs on HbA1c reduction. We also used Google Scholar and a hand search to identify additional studies. Thirty-four studies (40 estimates) met the criteria and were included in the analysis. Overall, introduction of HITs to standard diabetes treatment resulted in a statistically and clinically reduced HbA1c. The bias adjusted HbA1c reduction due to the combined HIT interventions was − 0.56 [Hedges’ g = − 0.56 (− 0.70, − 0.43)]. The reduction was significant across each of the four types of HIT intervention under review, with mobile phone-based approaches generating the largest effects [Hedges’ g was − 0.67 (− 0.90, − 0.45)]. HITs can be an effective tool for glycemic control among patients with type 2 diabetes. Future studies should examine long-term effects of HITs and explore factors that influence their effectiveness.Electronic supplementary materialThe online version of this article (10.1007/s11892-018-1105-2) contains supplementary material, which is available to authorized users.

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Meta-analysis of telemonitoring to improve HbA1c levels: Promise for stroke survivors

Cited by 22 publications

References 41 publications

Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer

Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer

Obesity paradox on the survival of elderly patients with diabetes: an AHAP-based study

Effect of Health Information Technologies on Glycemic Control Among Patients with Type 2 Diabetes

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