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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 clinical parameter—maternal outcomes (telemedicine vs control group).
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figure5: Forest plot showing the pooled clinical parameter—maternal outcomes (telemedicine vs control group).

Mentions: Maternal outcomes were reported variously across the trials. A total of 4 trials (148 women using telemedicine and 145 controls) reported differences between rates of pregnancy-induced hypertension or preeclampsia [27-29]. In these trials, 7.5% of women overall had either of these conditions; however, there was no difference in the risk ratio between the telemedicine or control groups (Figure 5). When considering the mode of delivery, rates of Cesarean section were high in both the groups (50.0% in the telemedicine and 45.0% in the control) with no difference in the risk ratio. Only 2 trials (150 women) reported shoulder dystocia [29], however, with only 1 case of shoulder dystocia meta-analysis was not possible.


Telemedicine Technologies for Diabetes in Pregnancy: A Systematic Review and Meta-Analysis
Forest plot showing the pooled clinical parameter—maternal outcomes (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

figure5: Forest plot showing the pooled clinical parameter—maternal outcomes (telemedicine vs control group).
Mentions: Maternal outcomes were reported variously across the trials. A total of 4 trials (148 women using telemedicine and 145 controls) reported differences between rates of pregnancy-induced hypertension or preeclampsia [27-29]. In these trials, 7.5% of women overall had either of these conditions; however, there was no difference in the risk ratio between the telemedicine or control groups (Figure 5). When considering the mode of delivery, rates of Cesarean section were high in both the groups (50.0% in the telemedicine and 45.0% in the control) with no difference in the risk ratio. Only 2 trials (150 women) reported shoulder dystocia [29], however, with only 1 case of shoulder dystocia meta-analysis was not possible.

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.