Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials.
OBJECTIVE
To assess the overall effect of telemedicine on diabetes management and to identify features of telemedicine interventions that are associated with better diabetes management outcomes.


METHODS
Hedges's g was estimated as the summary measure of mean difference in HbA1c between patients with diabetes who went through telemedicine care and those who went through conventional, non-telemedicine care using a random-effects model. Q statistics were calculated to assess if the effect of telemedicine on diabetes management differs by types of diabetes, age groups of patients, duration of intervention, and primary telemedicine approaches used.


RESULTS
The analysis included 55 randomized controlled trials with a total of 9258 patients with diabetes, out of which 4607 were randomized to telemedicine groups and 4651 to conventional, non-telemedicine care groups. The results favored telemedicine over conventional care (Hedges's g=-0.48, p<0.001) in diabetes management. The beneficial effect of telemedicine were more pronounced among patients with type 2 diabetes (Hedges's g=-0.63, p<0.001) than among those with type 1 diabetes (Hedges's g=-0.27, p=0.027) (Q=4.25, p=0.04).


CONCLUSIONS
Compared to conventional care, telemedicine is more effective in improving treatment outcomes for diabetes patients, especially for those with type 2 diabetes.
College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States.
Dejun
D
Su
College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States. Electronic address: junmin.zhou@unmc.edu.
Junmin
J
Zhou
College of Education and Human Services, University of Nebraska-Lincoln, Lincoln, NE, United States.
Megan S
MS
Kelley
College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States.
Tzeyu L
TL
Michaud
College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States.
Mohammad
M
Siahpush
College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States.
Jungyoon
J
Kim
College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States.
Fernando
F
Wilson
School of Public Health, City University of New York, New York, NY, United States.
Jim P
JP
Stimpson
New York Academy of Medicine, New York, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States.
José A
JA
Pagán
D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome
Diabetes management; Meta-analysis; Telemedicine