title: Does nutritional counseling in telemedicine improve treatment outcomes for diabetes? A systematic review and meta-analysis of results from 92 studies.
abstract: BACKGROUND
  A growing number of studies and reviews have documented the impact of telemedicine on diabetes management. However, no meta-analysis has assessed whether including nutritional counseling as part of a telemedicine program has a significant impact on diabetes outcomes or what kind of nutritional counseling is most effective.
  
  
  METHODS
  Original research articles examining the effect of telemedicine interventions on HbA1c levels in patients with Type 1 or Type 2 diabetes were included in this study. A literature search was performed and 92 studies were retained for analysis. We examined stratified results by differentiating interventions using no nutritional counseling from those that used nutritional counseling. We further compared between nutritional counseling administered via short message systems (SMS) such as email and text messages, and nutritional counseling administered via telephone or videoconference.
  
  
  RESULTS
  Telemedicine programs that include a nutritional component show similar effect in diabetes management as those programs that do not. Furthermore, subgroup analysis reveals that nutritional intervention via SMS such as email and text messages is at least as equally effective in reducing HbA1c when compared to personal nutritional counseling with a practitioner over videoconference or telephone.
  
  
  CONCLUSIONS
  The inclusion of nutritional counseling as part of a telemedicine program does not make a significant difference to diabetes outcomes. Incorporating nutritional counseling into telemedicine programs via SMS is at least as effective as counseling via telephone or videoconference.
authors.affiliation: Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Dejun
authors.initials: D
authors.lastname: Su
authors.affiliation: Brigham Young University, Provo, UT, USA chelsea61111@gmail.com.
authors.forename: Chelsea
authors.initials: C
authors.lastname: McBride
authors.affiliation: Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Junmin
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Nutrition and Health Sciences, College of Education and Human Sciences, University of Nebraska-Lincoln, USA.
authors.forename: Megan S
authors.initials: MS
authors.lastname: Kelley
mesh_terms: D003376:Counseling / Q000379:methods*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D052756:Nutritional Sciences; D016032:Randomized Controlled Trials as Topic; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Telemedicine; diabetes management; nutritional counseling; tele-nutrition design