Comparison of three insulin bolus calculators to increase time in range of glycemia in a group of poorly controlled adults Type 1 diabetes in a Brazilian public health service

Effectiveness of Telemedicine-Delivered Carbohydrate-Counting Interventions in Patients With Type 1 Diabetes: Systematic Review and Meta-Analysis

BACKGROUND

Type 1 diabetes mellitus (T1DM) significantly affects patients' quality of life and can be life-threatening, necessitating improved monitoring strategies. Telemedicine, which leverages telecommunications technologies to deliver health care services and expertise, has the potential to enhance T1DM management. However, its effectiveness remains to be fully established.

OBJECTIVE

This study aims to evaluate the effectiveness of various telemedicine-based carbohydrate-counting (CC) interventions in patients with T1DM.

METHODS

This systematic review and meta-analysis searched 5 databases-PubMed, Web of Science, CINAHL, Embase, and Cochrane-as well as reference lists of retrieved articles on September 26, 2024, for randomized controlled trials (RCTs) assessing the effectiveness of telemedicine-based CC interventions in reducing glycated hemoglobin A1c (HbA1c) levels in patients with T1DM.

RESULTS

From 3612 citations, we identified 18 eligible RCTs (n=1627) from 14 regions for inclusion in the meta-analysis. Participants in the telemedicine intervention group experienced a 0.35% reduction in HbA1c levels (95% CI -0.54 to -0.16) compared with the control group. A total of 13 studies used smartphone apps, 4 used connected and wearable glucometers, and 3 delivered the intervention through web-based systems. Significant reductions in HbA1c were observed across smartphone apps (-0.36%, 95% CI -0.63% to -0.09%), connected and wearable glucometers (-0.35%, 95% CI -0.56% to -0.14%), and web-based systems (-0.36%, 95% CI -0.71% to -0.02%). Considerable heterogeneity was noted (I2=81%, P<.001). Telemedicine-based CC interventions also increased time in range by 9.59% (95% CI 6.50%-12.67%). However, evidence regarding treatment satisfaction, total daily insulin dose, and hypoglycemia remains inconclusive. Subgroup analysis showed that telemedicine platform variety did not significantly contribute to heterogeneity, while meta-regression indicated that the impact on HbA1c was most pronounced in trials conducted in Asia.

CONCLUSIONS

Compared with usual care, telemedicine-delivered CC interventions improved HbA1c and time in range but did not significantly impact other clinically relevant outcomes in patients with T1DM. High-quality, large-scale RCTs are needed to draw definitive conclusions. These findings provide health care professionals with updated evidence on the role of telemedicine in glycemic control for patients with T1DM.

TRIAL REGISTRATION

PROSPERO CRD42024523025; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024523025.

The effect of bolus advisors on glycaemic parameters in adults with diabetes on intensive insulin therapy: A systematic review with meta-analysis

AIM

To conduct a systematic review with meta-analysis to provide a comprehensive synthesis of randomized controlled trials (RCTs) and prospective cohort studies investigating the effects of currently available bolus advisors on glycaemic parameters in adults with diabetes.

MATERIALS AND METHODS

An electronic search of PubMed, Embase, CINAHL, Cochrane Library and ClinicalTrials.gov was conducted in December 2022. The risk of bias was assessed using the revised Cochrane Risk of Bias tool. (Standardized) mean difference (MD) was selected to determine the difference in continuous outcomes between the groups. A random-effects model meta-analysis and meta-regression were performed. This systematic review was registered on PROSPERO (CRD42022374588).

RESULTS

A total of 18 RCTs involving 1645 adults (50% females) with a median glycated haemoglobin (HbA1c) concentration of 8.45% (7.95%-9.30%) were included. The majority of participants had type 1 diabetes (N = 1510, 92%) and were on multiple daily injections (N = 1173, 71%). Twelve of the 18 trials had low risk of bias. The meta-analysis of 10 studies with available data on HbA1c showed that the use of a bolus advisor modestly reduced HbA1c compared to standard treatment (MD -011%, 95% confidence interval -0.22 to -0.01; I2 = 0%). This effect was accompanied by small improvements in low blood glucose index and treatment satisfaction, but not with reductions in hypoglycaemic events or changes in other secondary outcomes.

CONCLUSION

Use of a bolus advisor is associated with slightly better glucose control and treatment satisfaction in people with diabetes on intensive insulin treatment. Future studies should investigate whether personalizing bolus advisors using artificial intelligence technology can enhance these effects.