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

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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.


Distribution of bias in the included trials.
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figure2: Distribution of bias in the included trials.

Mentions: Overall, all the trials displayed potential sources of methodological bias (Figures 2 and 3). Owing to the nature of the intervention, blinding of participants and health care providers was not possible and therefore we elected to not include this as part of the risk of bias assessment. Considering the method of randomization, 2 trials were found to be at low risk of bias, reporting the use of computerized stratified block randomization [15,16]. The remainder either used methods that were likely to be of high risk of bias, or did not report this component. Only 1 trial reported use of an adequate allocation concealment method [17]. Two trials gave a full description of participants and losses to follow-up during their trial [16,17]. Other trials reported losses to follow-up or postrandomization exclusions, which potentially may have affected the results. Reporting bias is the selective reporting of some outcomes but not others depending on the nature and direction of the results [31]. Only 1 included trial was judged to be at low risk of reporting bias [17], reporting a comprehensive range of glucose and clinical outcomes.


Telemedicine Technologies for Diabetes in Pregnancy: A Systematic Review and Meta-Analysis
Distribution of bias in the included trials.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

figure2: Distribution of bias in the included trials.
Mentions: Overall, all the trials displayed potential sources of methodological bias (Figures 2 and 3). Owing to the nature of the intervention, blinding of participants and health care providers was not possible and therefore we elected to not include this as part of the risk of bias assessment. Considering the method of randomization, 2 trials were found to be at low risk of bias, reporting the use of computerized stratified block randomization [15,16]. The remainder either used methods that were likely to be of high risk of bias, or did not report this component. Only 1 trial reported use of an adequate allocation concealment method [17]. Two trials gave a full description of participants and losses to follow-up during their trial [16,17]. Other trials reported losses to follow-up or postrandomization exclusions, which potentially may have affected the results. Reporting bias is the selective reporting of some outcomes but not others depending on the nature and direction of the results [31]. Only 1 included trial was judged to be at low risk of reporting bias [17], reporting a comprehensive range of glucose and clinical outcomes.

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.