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Tuzon J, Mulkey DC. Implementing mobile text messaging on glycemic control in patients with diabetes mellitus. J Am Assoc Nurse Pract 2024:01741002-990000000-00199. [PMID: 38294289 DOI: 10.1097/jxx.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Uncontrolled blood glucose may lead to serious complications in patients with type two diabetes mellitus (T2DM). Patients may not have the support, motivation, or encouragement to adhere to the lifestyle changes necessary to control their T2DM. LOCAL PROBLEM More than 75% of the primary care clinic's patients are diagnosed with T2DM, with most patients at the practice site having an average hemoglobin A1c (HbA1c) level of 8.5%. The primary care clinic did not use text messaging to disseminate diabetes self-management education and support (DSMES) as outlined in Standard 4 of the American Diabetic Association's (ADA) clinical practice guideline. METHODS This evidence-based quality improvement project was conducted in a rural outpatient primary care clinic to determine whether implementing the ADA's 2022 National Standards for DSMES using text messaging would affect HbA1C levels among adult patients with T2DM. INTERVENTIONS Patients were sent weekly text messages over a 12-week period. Text messages contained information promoting self-care, tips about healthy diet, exercise reminders, instructions about proper blood glucose monitoring, and reminders about medication adherence. RESULTS A total of 160 patients were included. A paired-sample t-test showed a reduction in HbA1c levels after the intervention from baseline (M = 7.53, SD = 1.72) to postimplementation (M = 6.91, SD = 0.89), t (159) = 11.88, p = .001. CONCLUSION Based on the results, implementing the ADA's National Standards for DSMES Standard 4 may affect HbA1c levels in this population.
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Affiliation(s)
- Jan Tuzon
- VA Long Beach Healthcare System, Employee Occupational Health, Long Beach, California
| | - David C Mulkey
- Grand Canyon University, College of Nursing and Health Care Professions, Phoenix, Arizona
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Livingstone KM, Rawstorn JC, Partridge SR, Godrich SL, McNaughton SA, Hendrie GA, Blekkenhorst LC, Maddison R, Zhang Y, Barnett S, Mathers JC, Packard M, Alston L. Digital behaviour change interventions to increase vegetable intake in adults: a systematic review. Int J Behav Nutr Phys Act 2023; 20:36. [PMID: 36973716 PMCID: PMC10042405 DOI: 10.1186/s12966-023-01439-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Digital interventions may help address low vegetable intake in adults, however there is limited understanding of the features that make them effective. We systematically reviewed digital interventions to increase vegetable intake to 1) describe the effectiveness of the interventions; 2) examine links between effectiveness and use of co-design, personalisation, behavioural theories, and/or a policy framework; and 3) identify other features that contribute to effectiveness. METHODS A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Library, INFORMIT, IEEE Xplore and Clinical Trial Registries, published between January 2000 and August 2022. Digital interventions to increase vegetable intake were included, with effective interventions identified based on statistically significant improvement in vegetable intake. To identify policy-action gaps, studies were mapped across the three domains of the NOURISHING framework (i.e., behaviour change communication, food environment, and food system). Risk of bias was assessed using Cochrane tools for randomized, cluster randomized and non-randomized trials. RESULTS Of the 1,347 records identified, 30 studies were included. Risk of bias was high or serious in most studies (n = 25/30; 83%). Approximately one quarter of the included interventions (n = 8) were effective at improving vegetable intake. While the features of effective and ineffective interventions were similar, embedding of behaviour change theories (89% vs 61%) and inclusion of stakeholders in the design of the intervention (50% vs 38%) were more common among effective interventions. Only one (ineffective) intervention used true co-design. Although fewer effective interventions included personalisation (67% vs 81%), the degree of personalisation varied considerably between studies. All interventions mapped across the NOURISHING framework behaviour change communication domain, with one ineffective intervention also mapping across the food environment domain. CONCLUSION Few digital interventions identified in this review were effective for increasing vegetable intake. Embedding behaviour change theories and involving stakeholders in intervention design may increase the likelihood of success. The under-utilisation of comprehensive co-design methods presents an opportunity to ensure that personalisation approaches better meet the needs of target populations. Moreover, future digital interventions should address both behaviour change and food environment influences on vegetable intake.
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Affiliation(s)
- Katherine M Livingstone
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, VIC, 3125, Melbourne, Australia.
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Stephanie R Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie L Godrich
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Bunbury, WA, 6230, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Gilly A Hendrie
- Human Health Program, Health & Biosecurity, CSIRO, Adelaide, SA, 5000, Australia
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Yuxin Zhang
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Scott Barnett
- Applied Artificial Intelligence Institute (A²I²), Deakin University, Geelong, Australia
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Maria Packard
- The National Heart Foundation of Australia, Melbourne, VIC, 3000, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Australia
- The Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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Kruse CS, Mileski M, Heinemann K, Huynh H, Leafblad A, Moreno E. Analyzing the Effectiveness of mHealth to Manage Diabetes Mellitus Among Adults Over 50: A Systematic Literature Review. J Multidiscip Healthc 2023; 16:101-117. [PMID: 36660039 PMCID: PMC9842522 DOI: 10.2147/jmdh.s392693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023] Open
Abstract
Purpose A total of 537 million suffered from diabetes mellitus in 2021, and the aging of the population will not abate this number in the future. Diabetes predisposes people to ailments and doubles the risk of COVID-19 mortality. mHealth has shown promise to help manage diabetes. The aim of this review is to objectively analyze research from the last 2.5 years to assess effectiveness where mHealth has been used as an intervention to help manage diabetes in older patients. We also analyzed patient satisfaction, quality, and barriers to adoption of mHealth to manage diabetes. Patients and Methods No human subjects were involved in this review. We queried four research databases for mHealth to manage diabetes in older adults. We conducted the review based on the Kruse Protocol for writing as systematic review and we reported our findings in accordance with PRISMA (2020). Results Thirty research articles from 11 countries were analyzed. Five interventions of mHealth were identified. Of these mHealth Short Message service (SMS) helped change behavior and encouraged self-care. mHealth SMS coupled with telemedicine for coaching showed positive effects on weight loss, BMI, diet, exercise, HbA1C, disease awareness, blood pressure, cholesterol, medication adherence, and foot care. Conclusion mHealth SMS coupled with telemedicine for coaching shows the greatest promise for educating, changing behavior, and realizing positive outcomes across a broad spectrum of health factors. The largest drawback is the cost of acquiring equipment and training users.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Michael Mileski
- School of Health Administration, Texas State University, San Marcos, TX, USA,Correspondence: Michael Mileski, Texas State University, School of Health Administration, 601 University Drive, Encino Hall—250, San Marcos, TX, 78666, USA, Tel +1 512 245 3556, Email
| | - Katharine Heinemann
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Hung Huynh
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Abigail Leafblad
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Emmanuel Moreno
- School of Health Administration, Texas State University, San Marcos, TX, USA
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Kosowicz L, Tran K, Khanh TT, Dang TH, Pham VA, Ta Thi Kim H, Thi Bach Duong H, Nguyen TD, Phuong AT, Le TH, Ta VA, Wickramasinghe N, Schofield P, Zelcer J, Pham Le T, Nguyen TA. Lessons for Vietnam on the use of digital technologies to support patient-centred care in low- and middle-income countries in the Asia Pacific Region: A scoping review (Preprint). J Med Internet Res 2022; 25:e43224. [PMID: 37018013 PMCID: PMC10132046 DOI: 10.2196/43224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/11/2023] [Accepted: 02/01/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A rapidly aging population, a shifting disease burden and the ongoing threat of infectious disease outbreaks pose major concerns for Vietnam's health care system. Health disparities are evident in many parts of the country, especially in rural areas, and the population faces inequitable access to patient-centered health care. Vietnam must therefore explore and implement advanced solutions to the provision of patient-centered care, with a view to reducing pressures on the health care system simultaneously. The use of digital health technologies (DHTs) may be one of these solutions. OBJECTIVE This study aimed to identify the application of DHTs to support the provision of patient-centered care in low- and middle-income countries in the Asia-Pacific region (APR) and to draw lessons for Vietnam. METHODS A scoping review was undertaken. Systematic searches of 7 databases were conducted in January 2022 to identify publications on DHTs and patient-centered care in the APR. Thematic analysis was conducted, and DHTs were classified using the National Institute for Health and Care Excellence evidence standards framework for DHTs (tiers A, B, and C). Reporting was in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. RESULTS Of the 264 publications identified, 45 (17%) met the inclusion criteria. The majority of the DHTs were classified as tier C (15/33, 45%), followed by tier B (14/33, 42%) and tier A (4/33, 12%). At an individual level, DHTs increased accessibility of health care and health-related information, supported individuals in self-management, and led to improvements in clinical and quality-of-life outcomes. At a systems level, DHTs supported patient-centered outcomes by increasing efficiency, reducing strain on health care resources, and supporting patient-centered clinical practice. The most frequently reported enablers for the use of DHTs for patient-centered care included alignment of DHTs with users' individual needs, ease of use, availability of direct support from health care professionals, provision of technical support as well as user education and training, appropriate governance of privacy and security, and cross-sectorial collaboration. Common barriers included low user literacy and digital literacy, limited user access to DHT infrastructure, and a lack of policies and protocols to guide the implementation and use of DHTs. CONCLUSIONS The use of DHTs is a viable option to increase equitable access to quality, patient-centered care across Vietnam and simultaneously reduce pressures on the health care system. Vietnam can take advantage of the lessons learned by other low- and middle-income countries in the APR when developing a national road map to digital health transformation. Recommendations that Vietnamese policy makers may consider include emphasizing stakeholder engagement, strengthening digital literacy, supporting the improvement of DHT infrastructure, increasing cross-sectorial collaboration, strengthening governance of cybersecurity, and leading the way in DHT uptake.
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Affiliation(s)
- Leona Kosowicz
- Social Gerontology Division, National Ageing Research Institute, Parkville, Australia
| | - Kham Tran
- Social Gerontology Division, National Ageing Research Institute, Parkville, Australia
| | - Toan Tran Khanh
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Thu Ha Dang
- Social Gerontology Division, National Ageing Research Institute, Parkville, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | | | - Hue Ta Thi Kim
- New Horizon Palliative Care Company Limited, Hanoi, Vietnam
- Hanoi University of Science and Technology, Hanoi, Vietnam
| | | | | | | | | | - Van Anh Ta
- New Horizon Palliative Care Company Limited, Hanoi, Vietnam
| | - Nilmini Wickramasinghe
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | - Penelope Schofield
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - John Zelcer
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | - Tuan Pham Le
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
- Military and Civil Medical Association of Vietnam, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Parkville, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
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Hategeka C, Adu P, Desloge A, Marten R, Shao R, Tian M, Wei T, Kruk ME. Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review. PLoS Med 2022; 19:e1004055. [PMID: 35877677 PMCID: PMC9359585 DOI: 10.1371/journal.pmed.1004055] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 08/08/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs). METHODS AND FINDINGS On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework. CONCLUSIONS Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allissa Desloge
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | | | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ting Wei
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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Hangaard S, Laursen SH, Andersen JD, Kronborg T, Vestergaard P, Hejlesen O, Udsen FW. The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression. J Diabetes Sci Technol 2021; 17:794-825. [PMID: 34957864 DOI: 10.1177/19322968211064633] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of -0.415% (95% confidence interval [CI] = -0.482% to -0.348%). The heterogeneity was great (I2 = 93.05%). A monitoring component gave rise to the higher effects of telemedicine. CONCLUSIONS In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.
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Affiliation(s)
- Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Sisse H Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Nursing, University College of Northern Denmark, Aalborg, Denmark
| | - Jonas D Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W Udsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Correia JC, Meraj H, Teoh SH, Waqas A, Ahmad M, Lapão LV, Pataky Z, Golay A. Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ 2020; 99:209-219B. [PMID: 33716343 PMCID: PMC7941107 DOI: 10.2471/blt.19.250068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022] Open
Abstract
Objective To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. Methods We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties. Findings We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of −0.38 for glycated haemoglobin (95% confidence interval, CI: −0.52 to −0.23; I2 = 86.70%), −0.20 for fasting blood sugar (95% CI: −0.32 to −0.08; I2 = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I2 = 93.75%), 0.55 for diabetes knowledge (95% CI: −0.10 to 1.20; I2 = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I2 = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of −0.04 for body mass index (95% CI: −0.13 to 0.05; I2 = 35.94%), −0.06 for total cholesterol (95% CI: −0.16 to 0.04; I2 = 59.93%) and −0.02 for triglycerides (95% CI: −0.12 to 0.09; I2 = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications. Conclusion Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.
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Affiliation(s)
- Jorge César Correia
- Department of Medicine, Geneva University Hospitals, Chemin Venel 7, 1206 Geneva, Switzerland
| | - Hafsa Meraj
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, Wales
| | - Soo Huat Teoh
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Ahmed Waqas
- Institute of Population Health, University of Liverpool, Liverpool, England
| | - Maaz Ahmad
- Department of Oral Biology, Sharif Medical and Dental College, Lahore, Pakistan
| | - Luis Velez Lapão
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zoltan Pataky
- Department of Medicine, Geneva University Hospitals, Chemin Venel 7, 1206 Geneva, Switzerland
| | - Alain Golay
- Department of Medicine, Geneva University Hospitals, Chemin Venel 7, 1206 Geneva, Switzerland
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