title: Telemedicine application in the care of diabetes patients: systematic review and meta-analysis.
abstract: BACKGROUND
  The impact of telemedicine application on the management of diabetes patients is unclear, as the results are not consistent among different studies. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of telemedicine interventions on change in hemoglobin A1c (HbA1c), blood pressure, LDL cholesterol (LDL-c) and body mass index (BMI) in diabetes patients.
  
  
  METHODS
  Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched to identify relevant studies published until April 2012, supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Of the 6.258 articles retrieved, 13 RCTs (4207 patients) were included. Random effects model was applied to estimate the pooled results.
  
  
  RESULTS
  Telemedicine was associated with a statistically significant and clinically relevant absolute decline in HbA1c level compared to control (mean difference -0.44% [-4.8 mmol/mol] and 95% confidence interval [CI] -0.61 to -0.26% [-6.7 to -2.8 mmol/mol]; p<0.001). LDL-c was reduced in 6.6 mg/dL (95% CI -8.3 to -4.9; p<0.001), but the clinical relevance of this effect can be questioned. No effects of telemedicine strategies were seen on systolic (-1.6 mmHg and 95% CI -7.2 to 4.1) and diastolic blood pressure (-1.1 mmHg and 95% CI -3.0 to 0.8). The 2 studies that assessed the effect on BMI demonstrated a tendency of BMI reduction in favor of telemedicine.
  
  
  CONCLUSIONS
  Telemedicine strategies combined to the usual care were associated with improved glycemic control in diabetic patients. No clinical relevant impact was observed on LDL-c and blood pressure, and there was a tendency of BMI reduction in diabetes patients who used telemedicine, but these outcomes should be further explored in future trials.
authors.affiliation: Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil ; University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Milena Soriano
authors.initials: MS
authors.lastname: Marcolino
authors.forename: Junia Xavier
authors.initials: JX
authors.lastname: Maia
authors.forename: Maria Beatriz Moreira
authors.initials: MB
authors.lastname: Alkmim
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Antonio Luiz
authors.initials: AL
authors.lastname: Ribeiro
mesh_terms: D001786:Blood Glucose; D001794:Blood Pressure; D015992:Body Mass Index; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000503:physiopathology / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D016239:MEDLINE; D016032:Randomized Controlled Trials as Topic; D017216:Telemedicine / Q000379:methods*
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin