Telemedicine Technologies for Diabetes in Pregnancy: A Systematic Review and Meta-Analysis.
Diabetes in pregnancy is a global problem. Technological innovations present exciting opportunities for novel approaches to improve clinical care delivery for gestational and other forms of diabetes in pregnancy.



To perform an updated and comprehensive systematic review and meta-analysis of the literature to determine whether telemedicine solutions offer any advantages compared with the standard care for women with diabetes in pregnancy.



The review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Randomized controlled trials (RCT) in women with diabetes in pregnancy that compared telemedicine blood glucose monitoring with the standard care were identified. Searches were performed in SCOPUS and PubMed, limited to English language publications between January 2000 and January 2016. Trials that met the eligibility criteria were scored for risk of bias using the Cochrane Collaborations Risk of Bias Tool. A meta-analysis was performed using Review Manager software version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration).



A total of 7 trials were identified. Meta-analysis demonstrated a modest but statistically significant improvement in HbA1c associated with the use of a telemedicine technology. The mean HbA1c of women using telemedicine was 5.33% (SD 0.70) compared with 5.45% (SD 0.58) in the standard care group, representing a mean difference of -0.12% (95% CI -0.23% to -0.02%). When this comparison was limited to women with gestational diabetes mellitus (GDM) only, the mean HbA1c of women using telemedicine was 5.22% (SD 0.70) compared with 5.37% (SD 0.61) in the standard care group, mean difference -0.14% (95% CI -0.25% to -0.04%). There were no differences in other maternal and neonatal outcomes reported.



There is currently insufficient evidence that telemedicine technology is superior to standard care for women with diabetes in pregnancy; however, there was no evidence of harm. No trials were identified that assessed patient satisfaction or cost of care delivery, and it may be in these areas where these technologies may be found most valuable.
Nuffield Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford, United Kingdom.|Department of Obstetrics & Gynaecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Wai-Kit
0000-0002-8846-7515
WK
Ming
Women's Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
Lucy H
0000-0002-1927-1594
LH
Mackillop
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Andrew J
0000-0002-6170-4402
AJ
Farmer
Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.
Lise
0000-0002-1141-6680
L
Loerup
Women's Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
Katy
0000-0002-2323-2141
K
Bartlett
The Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
Jonathan C
0000-0003-1007-2393
JC
Levy
Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.
Lionel
0000-0002-0118-1646
L
Tarassenko
Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.
Carmelo
0000-0003-4836-3743
C
Velardo
Nuffield Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford, United Kingdom.
Yvonne
0000-0002-2037-9244
Y
Kenworthy
Nuffield Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford, United Kingdom.
Jane E
0000-0002-0176-2651
JE
Hirst
D016640:Diabetes, Gestational / Q000628:therapy*; D005260:Female; D006801:Humans; D011247:Pregnancy; D017216:Telemedicine / Q000379:methods*
diabetes mellitus; meta-analysis; pregnancy; pregnancy in diabetics; review; telemedicine