title: Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials.
abstract: BACKGROUND
  Telemedicine, the use of telecommunications to deliver health services, expertise and information, is a promising but unproven tool for improving the quality of diabetes care. We summarized the effectiveness of different methods of telemedicine for the management of diabetes compared with usual care.
  
  
  METHODS
  We searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials databases (to November 2015) and reference lists of existing systematic reviews for randomized controlled trials (RCTs) comparing telemedicine with usual care for adults with diabetes. Two independent reviewers selected the studies and assessed risk of bias in the studies. The primary outcome was glycated hemoglobin (HbA1C) reported at 3 time points (≤ 3 mo, 4-12 mo and > 12 mo). Other outcomes were quality of life, mortality and episodes of hypoglycemia. Trials were pooled using randomeffects meta-analysis, and heterogeneity was quantified using theI2statistic.
  
  
  RESULTS
  From 3688 citations, we identified 111 eligible RCTs (n= 23 648). Telemedicine achieved significant but modest reductions in HbA1Cin all 3 follow-up periods (difference in mean at ≤ 3 mo: -0.57%, 95% confidence interval [CI] -0.74% to -0.40% [39 trials]; at 4-12 mo: -0.28%, 95% CI -0.37% to -0.20% [87 trials]; and at > 12 mo: -0.26%, 95% CI -0.46% to -0.06% [5 trials]). Quantified heterogeneity (I2statistic) was 75%, 69% and 58%, respectively. In meta-regression analyses, the effect of telemedicine on HbA1Cappeared greatest in trials with higher HbA1Cconcentrations at baseline, in trials where providers used Web portals or text messaging to communicate with patients and in trials where telemedicine facilitated medication adjustment. Telemedicine had no convincing effect on quality of life, mortality or hypoglycemia.
  
  
  CONCLUSIONS
  Compared with usual care, the addition of telemedicine, especially systems that allowed medication adjustments with or without text messaging or a Web portal, improved HbA1Cbut not other clinically relevant outcomes among patients with diabetes.
authors: Department of Medicine, Royal Alexandra Hospital (Faruque), Edmonton, Alta.; Department of Medicine (Wiebe, Liu), University of Alberta, Edmonton, Alta.; Department of Medicine (Ehteshami-Afshar, Dianati-Maleki), Mount Sinai West and Mount Sinai St. Luke's Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine (Hemmelgarn, Manns, Tonelli), University of Calgary, Calgary, Alta.
authors: Labib Imran
authors: LI
authors: Faruque
authors: Department of Medicine, Royal Alexandra Hospital (Faruque), Edmonton, Alta.; Department of Medicine (Wiebe, Liu), University of Alberta, Edmonton, Alta.; Department of Medicine (Ehteshami-Afshar, Dianati-Maleki), Mount Sinai West and Mount Sinai St. Luke's Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine (Hemmelgarn, Manns, Tonelli), University of Calgary, Calgary, Alta.
authors: Natasha
authors: N
authors: Wiebe
authors: Department of Medicine, Royal Alexandra Hospital (Faruque), Edmonton, Alta.; Department of Medicine (Wiebe, Liu), University of Alberta, Edmonton, Alta.; Department of Medicine (Ehteshami-Afshar, Dianati-Maleki), Mount Sinai West and Mount Sinai St. Luke's Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine (Hemmelgarn, Manns, Tonelli), University of Calgary, Calgary, Alta.
authors: Arash
authors: A
authors: Ehteshami-Afshar
authors: Department of Medicine, Royal Alexandra Hospital (Faruque), Edmonton, Alta.; Department of Medicine (Wiebe, Liu), University of Alberta, Edmonton, Alta.; Department of Medicine (Ehteshami-Afshar, Dianati-Maleki), Mount Sinai West and Mount Sinai St. Luke's Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine (Hemmelgarn, Manns, Tonelli), University of Calgary, Calgary, Alta.
authors: Yuanchen
authors: Y
authors: Liu
authors: Department of Medicine, Royal Alexandra Hospital (Faruque), Edmonton, Alta.; Department of Medicine (Wiebe, Liu), University of Alberta, Edmonton, Alta.; Department of Medicine (Ehteshami-Afshar, Dianati-Maleki), Mount Sinai West and Mount Sinai St. Luke's Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine (Hemmelgarn, Manns, Tonelli), University of Calgary, Calgary, Alta.
authors: Neda
authors: N
authors: Dianati-Maleki
authors: Department of Medicine, Royal Alexandra Hospital (Faruque), Edmonton, Alta.; Department of Medicine (Wiebe, Liu), University of Alberta, Edmonton, Alta.; Department of Medicine (Ehteshami-Afshar, Dianati-Maleki), Mount Sinai West and Mount Sinai St. Luke's Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine (Hemmelgarn, Manns, Tonelli), University of Calgary, Calgary, Alta.
authors: Brenda R
authors: BR
authors: Hemmelgarn
authors: Department of Medicine, Royal Alexandra Hospital (Faruque), Edmonton, Alta.; Department of Medicine (Wiebe, Liu), University of Alberta, Edmonton, Alta.; Department of Medicine (Ehteshami-Afshar, Dianati-Maleki), Mount Sinai West and Mount Sinai St. Luke's Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine (Hemmelgarn, Manns, Tonelli), University of Calgary, Calgary, Alta.
authors: Braden J
authors: BJ
authors: Manns
authors: Department of Medicine, Royal Alexandra Hospital (Faruque), Edmonton, Alta.; Department of Medicine (Wiebe, Liu), University of Alberta, Edmonton, Alta.; Department of Medicine (Ehteshami-Afshar, Dianati-Maleki), Mount Sinai West and Mount Sinai St. Luke's Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine (Hemmelgarn, Manns, Tonelli), University of Calgary, Calgary, Alta. tonelli.admin@ucalgary.ca.
authors: Marcello
authors: M
authors: Tonelli
mesh_terms: D003142:Communication; D003920:Diabetes Mellitus / Q000097:blood* / Q000628:therapy*; D019468:Disease Management; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000517:prevention & control; D020407:Internet; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D017216:Telemedicine; D060145:Text Messaging
chemical_list: D006442:Glycated Hemoglobin