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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.


Forest plot showing the pooled HbA1c and blood glucose level (telemedicine vs control group).
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figure4: Forest plot showing the pooled HbA1c and blood glucose level (telemedicine vs control group).

Mentions: HbA1c was the most commonly reported glycemic outcome in 5 trials [21,28-30]. Meta-analysis demonstrated a modest, but statistically significant, improvement in HbA1c associated with the use of a telemedicine. 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 the 4 trials of women with GDM only, the difference was slightly greater [21,28,29]. The mean HbA1c of women with GDM using telemedicine was 5.23% (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%). Three trials (175 women: 143 GDM and 32 type 1) compared the overall mean blood glucose levels between the intervention (telemedicine) and control (standard care) groups [27,28,30]. Meta-analysis of these trials demonstrated no evidence of difference in mean blood glucose levels; however, this was in keeping with the lack of difference in HbA1c also observed in these individual trials (Figure 4). Two of these trials reported differences between fasting and 2 h postprandial blood glucose, however, no significant difference was demonstrated between the groups [15,28]. One trial in women with type 1 diabetes reported the mean units of insulin used in each group [15]. For these 19 women, the telemedicine group used a greater total dose of insulin compared with standard care, 54 units (SD 7 units) and 36 units (SD 6 units), respectively.


Telemedicine Technologies for Diabetes in Pregnancy: A Systematic Review and Meta-Analysis
Forest plot showing the pooled HbA1c and blood glucose level (telemedicine vs control group).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

figure4: Forest plot showing the pooled HbA1c and blood glucose level (telemedicine vs control group).
Mentions: HbA1c was the most commonly reported glycemic outcome in 5 trials [21,28-30]. Meta-analysis demonstrated a modest, but statistically significant, improvement in HbA1c associated with the use of a telemedicine. 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 the 4 trials of women with GDM only, the difference was slightly greater [21,28,29]. The mean HbA1c of women with GDM using telemedicine was 5.23% (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%). Three trials (175 women: 143 GDM and 32 type 1) compared the overall mean blood glucose levels between the intervention (telemedicine) and control (standard care) groups [27,28,30]. Meta-analysis of these trials demonstrated no evidence of difference in mean blood glucose levels; however, this was in keeping with the lack of difference in HbA1c also observed in these individual trials (Figure 4). Two of these trials reported differences between fasting and 2 h postprandial blood glucose, however, no significant difference was demonstrated between the groups [15,28]. One trial in women with type 1 diabetes reported the mean units of insulin used in each group [15]. For these 19 women, the telemedicine group used a greater total dose of insulin compared with standard care, 54 units (SD 7 units) and 36 units (SD 6 units), respectively.

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.