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Telemedicine Technologies for Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Diabetes in pregnancy is a global problem. Technological innovations present exciting opportunities for novel approaches to improve clinical care delivery for gestational and other forms of diabetes in pregnancy.

Objective: To perform an updated and comprehensive systematic review and meta-analysis of the literature to determine whether telemedicine solutions offer any advantages compared with the standard care for women with diabetes in pregnancy.

Methods: The review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Randomized controlled trials (RCT) in women with diabetes in pregnancy that compared telemedicine blood glucose monitoring with the standard care were identified. Searches were performed in SCOPUS and PubMed, limited to English language publications between January 2000 and January 2016. Trials that met the eligibility criteria were scored for risk of bias using the Cochrane Collaborations Risk of Bias Tool. A meta-analysis was performed using Review Manager software version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration).

Results: A total of 7 trials were identified. Meta-analysis demonstrated a modest but statistically significant improvement in HbA1c associated with the use of a telemedicine technology. The mean HbA1c of women using telemedicine was 5.33% (SD 0.70) compared with 5.45% (SD 0.58) in the standard care group, representing a mean difference of −0.12% (95% CI −0.23% to −0.02%). When this comparison was limited to women with gestational diabetes mellitus (GDM) only, the mean HbA1c of women using telemedicine was 5.22% (SD 0.70) compared with 5.37% (SD 0.61) in the standard care group, mean difference −0.14% (95% CI −0.25% to −0.04%). There were no differences in other maternal and neonatal outcomes reported.

Conclusions: There is currently insufficient evidence that telemedicine technology is superior to standard care for women with diabetes in pregnancy; however, there was no evidence of harm. No trials were identified that assessed patient satisfaction or cost of care delivery, and it may be in these areas where these technologies may be found most valuable.

No MeSH data available.


Related in: MedlinePlus

Study selection. RTC: randomized controlled trial; GDM: gestational diabetes mellitus; T1 DM: type 1 diabetes mellitus; T2 DM: type 2 diabetes mellitus.
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figure1: Study selection. RTC: randomized controlled trial; GDM: gestational diabetes mellitus; T1 DM: type 1 diabetes mellitus; T2 DM: type 2 diabetes mellitus.

Mentions: The search and screening strategy is shown in Figure 1. Seven of the 54 trials selected for full-text review met the inclusion criteria, involving 579 women: 496 women with GDM (5 trials) [16,21,27-29] and 83 with type 1 diabetes (3 trials) [15,21,30]. The trial of Dalfra et al presented results separately for women with GDM and type 1 diabetes; thus, for analysis we present this trial stratified by diabetes type [21]. All trials were small in size, ranging from 19 to 203 women with a median of 57 (interquartile range 32-85). The 7 trials were all conducted in high-income countries (5 in Europe and 2 in North America). See Multimedia Appendix 1.


Telemedicine Technologies for Diabetes in Pregnancy: A Systematic Review and Meta-Analysis
Study selection. RTC: randomized controlled trial; GDM: gestational diabetes mellitus; T1 DM: type 1 diabetes mellitus; T2 DM: type 2 diabetes mellitus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5121530&req=5

figure1: Study selection. RTC: randomized controlled trial; GDM: gestational diabetes mellitus; T1 DM: type 1 diabetes mellitus; T2 DM: type 2 diabetes mellitus.
Mentions: The search and screening strategy is shown in Figure 1. Seven of the 54 trials selected for full-text review met the inclusion criteria, involving 579 women: 496 women with GDM (5 trials) [16,21,27-29] and 83 with type 1 diabetes (3 trials) [15,21,30]. The trial of Dalfra et al presented results separately for women with GDM and type 1 diabetes; thus, for analysis we present this trial stratified by diabetes type [21]. All trials were small in size, ranging from 19 to 203 women with a median of 57 (interquartile range 32-85). The 7 trials were all conducted in high-income countries (5 in Europe and 2 in North America). See Multimedia Appendix 1.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Diabetes in pregnancy is a global problem. Technological innovations present exciting opportunities for novel approaches to improve clinical care delivery for gestational and other forms of diabetes in pregnancy.

Objective: To perform an updated and comprehensive systematic review and meta-analysis of the literature to determine whether telemedicine solutions offer any advantages compared with the standard care for women with diabetes in pregnancy.

Methods: The review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Randomized controlled trials (RCT) in women with diabetes in pregnancy that compared telemedicine blood glucose monitoring with the standard care were identified. Searches were performed in SCOPUS and PubMed, limited to English language publications between January 2000 and January 2016. Trials that met the eligibility criteria were scored for risk of bias using the Cochrane Collaborations Risk of Bias Tool. A meta-analysis was performed using Review Manager software version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration).

Results: A total of 7 trials were identified. Meta-analysis demonstrated a modest but statistically significant improvement in HbA1c associated with the use of a telemedicine technology. The mean HbA1c of women using telemedicine was 5.33% (SD 0.70) compared with 5.45% (SD 0.58) in the standard care group, representing a mean difference of −0.12% (95% CI −0.23% to −0.02%). When this comparison was limited to women with gestational diabetes mellitus (GDM) only, the mean HbA1c of women using telemedicine was 5.22% (SD 0.70) compared with 5.37% (SD 0.61) in the standard care group, mean difference −0.14% (95% CI −0.25% to −0.04%). There were no differences in other maternal and neonatal outcomes reported.

Conclusions: There is currently insufficient evidence that telemedicine technology is superior to standard care for women with diabetes in pregnancy; however, there was no evidence of harm. No trials were identified that assessed patient satisfaction or cost of care delivery, and it may be in these areas where these technologies may be found most valuable.

No MeSH data available.


Related in: MedlinePlus