Telemedicine interventions for gestational diabetes mellitus: A systematic review and meta-analysis.
OBJECTIVE
To evaluate the effect of telemedicine on GDM service and maternal, and foetal outcomes.


METHODS
A systematic review and meta-analysis of randomised controlled trials (RCT) of telemedicine interventions for GDM was conducted. We searched English publications from 01/01/1990 to 31/08/2013, with further new publication tracking to June 2015 on MEDLINE, EMBASE, PUBMED, CINAHL, the Cochrane Central Register of Controlled Trials and the World Health Organization International Clinical Trials Registry electronic databases. Findings are presented as standardised mean difference (SMD) and odds ratios (OR) or narrative and quantitative description of findings where meta-analysis was not possible.


RESULTS
Our search yielded 721 abstracts. Four met the inclusion criteria; two publications arose from the same study, resulting in three studies for review. All studies compared telemedicine to usual care. Telemedicine was associated with significantly fewer unscheduled GDM clinic visits, SMD. Quality of life, glycaemic control (HbA1c, pre and postprandial blood glucose level (BGL)), and caesarean section rate were similar between the telemedicine and usual care groups. None of the studies evaluated costs.


CONCLUSIONS
Telemedicine has the potential to streamline GDM service utilisation without compromising maternal and foetal outcomes. Its advantage may lie in the convenience of reducing face-to-face and unscheduled consultations. Studies are limited and more trials that include cost evaluation are required.
Department of General Practice, The University of Melbourne, Parkville, VIC, Australia; Northern Clinical Research Centre, The Northern Hospital, Epping, VIC, Australia. Electronic address: tshepo.rasekaba@nh.org.au.
Tshepo M
TM
Rasekaba
Department of General Practice, The University of Melbourne, Parkville, VIC, Australia.
John
J
Furler
Department of General Practice, The University of Melbourne, Parkville, VIC, Australia; John Richards Initiative, La Trobe University, Wodonga, VIC, Australia.
Irene
I
Blackberry
Northern Clinical Research Centre, The Northern Hospital, Epping, VIC, Australia; Melbourne EpiCentre, The Royal Melbourne Hospital, Parkville, Australia.
Mark
M
Tacey
Health and Biomedical Informatics Centre, The University of Melbourne, Parkville, VIC, Australia.
Kathleen
K
Gray
Northern Clinical Research Centre, The Northern Hospital, Epping, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Department of Medicine, The Northern Hospital, Epping, VIC, Australia.
Kwang
K
Lim
D002585:Cesarean Section / Q000706:statistics & numerical data; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D017216:Telemedicine / Q000379:methods*
Gestational diabetes; Glycaemic control; Self-monitoring; Telehealth; Telemedicine