Effect of Telemetric Interventions on Glycated Hemoglobin A1c and Management of Type 2 Diabetes Mellitus: Systematic Meta-Review

BACKGROUND: Diabetes mellitus is a chronic burden, with a prevalence that is increasing worldwide. Telemetric interventions have attracted great interest and may provide effective new therapeutic approaches for improving type 2 diabetes mellitus (T2DM) care. OBJECTIVE: The objective of this study was to analyze the clinical effectiveness of telemetric interventions on glycated hemoglobin A(1c) (HbA(1c)) specifically and T2DM management generally in a systematic meta-review. METHODS: A systematic literature search was performed in PubMed, CINAHL, Cochrane Library, Web of Science Core Collection, and EMBASE databases from January 2008 to April 2020. Studies that addressed HbA(1c), blood pressure, fasting blood glucose, BMI, diabetes-related and health-related quality of life, cost-effectiveness, time savings, and the clinical effectiveness of telemetric interventions were analyzed. In total, 73 randomized controlled trials (RCTs), 10 systematic reviews/meta-analyses, 9 qualitative studies, 2 cohort studies, 2 nonrandomized controlled studies, 2 observational studies, and 1 noncontrolled intervention study were analyzed. RESULTS: Overall, 1647 citations were identified. After careful screening, 99 studies (n=15,939 patients; n=82,436 patient cases) were selected by two independent reviewers for inclusion in the review. Telemetric interventions were categorized according to communication channels to health care providers: (1) “real-time video” interventions, (2) “real-time audio” interventions, (3) “asynchronous” interventions, and (4) “combined” interventions. To analyze changes in HbA(1c), suitable RCTs were pooled and the average was determined. An HbA(1c) decrease of –1.15% (95% CI –1.84% to –0.45%), yielding an HbA(1c) value of 6.95% (SD 0.495), was shown in studies using 6-month “real-time video” interventions. CONCLUSIONS: Telemetric interventions clearly improve HbA(1c) values in both the short term and the long term and contribute to the effective management of T2DM. More studies need to be done in greater detail.