Background: Diabetes mellitus (DM) is one of the world’s greatest health threats with rising prevalence. Global digitalization leads to new digital approaches in diabetes management, such as telemedical interventions. Telemedicine, which is the use of information and communication technologies, may provide medical services over spatial distances to improve clinical patient outcomes by increasing access to diabetes care and medical information. Objective: This study aims to examine whether telemedical interventions effectively improve diabetes control using studies that pooled patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), and whether the benefits are greater in patients diagnosed with T2DM than in those diagnosed with T1DM. We analyzed the primary outcome glycated hemoglobin A1c (HbA1c) and the secondary outcomes fasting blood glucose (FBG), blood pressure (BP), body weight, BMI, quality of life (QoL), cost, and time saving. Methods: Publications were systematically identified by searching Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, Embase, and CINAHL databases for studies published between January 2008 and April 2020, considering systematic reviews (SRs), meta-analyses (MAs), randomized controlled trials (RCTs), and clinical trials (CTs). Study quality was assessed using the A Measurement Tool to Assess Systematic Reviews, Effective Public Health Practice Project, and National Institute for Health and Care Excellence qualitative checklist. We organized the trials by communication technologies in real-time video or audio interventions, asynchronous interventions, and combined interventions (synchronous and asynchronous communication). Results: From 1116 unique citations, we identified 31 eligible studies (n=15 high, n=14 moderate, n=1 weak, and n=1 critically low quality). We selected 21 SRs and MAs, 8 RCTs, 1 non-RCT, and 1 qualitative study. Of the 10 trials, 3 were categorized as real-time video, 1 as real-time video and audio, 4 as asynchronous, and 2 as combined intervention. Significant decline in HbA1c levels based on pooled T1DM and T2DM patients data ranged from −0.22% weighted mean difference (WMD; 95% CI −0.28 to −0.15; PP1c values might be significantly smaller for patients with T1DM than for patients with T2DM. Evidence on the impact on BP, body weight, FBG, cost effectiveness, and time saving was smaller compared with HbA1c but indicated potential in some publications. Conclusions: Telemedical interventions might be clinically effective in improving diabetes control overall, and they might significantly improve HbA1c concentrations. Patients with T2DM could benefit more than patients with T1DM regarding lowering HbA1c levels. Further studies with longer duration and larger cohorts are necessary.

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中文翻译：

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通过远程医疗干预管理1型和2型糖尿病的临床改善：系统的Meta审查。

背景：糖尿病（DM）是世界上最大的健康威胁之一，发病率不断上升。全球数字化导致了糖尿病管理中的新数字方法，例如远程医疗干预。远程医疗是信息和通信技术的一种使用，它可以通过增加对糖尿病护理和医疗信息的访问来在空间上提供医疗服务，从而改善临床患者的预后。目的：本研究旨在通过汇集1型糖尿病（T1DM）和2型糖尿病（T2DM）患者的研究，检查远程医疗干预措施是否能有效改善糖尿病控制，以及诊断为T2DM的患者是否比那些获益更大的患者诊断为T1DM。我们分析了主要结果糖化血红蛋白A1c（HbA1c）和次要结果空腹血糖（FBG），血压（BP），体重，BMI，生活质量（QoL），成本和节省时间。方法：通过系统评价（SR），荟萃分析（MAs），系统评价（CSR），荟萃分析（MAs），随机对照试验（RCT）和临床试验（CT）。研究质量是使用A评估工具评估系统评价，有效公共卫生实践项目和美国国家卫生与护理卓越研究所定性清单进行评估的。我们通过通讯技术在实时视频或音频干预中组织了试验，异步干预和组合干预（同步和异步通信）。结果：从1116次独特引用中，我们确定了31项合格研究（n = 15高，n = 14中，n = 1弱和n = 1严重低质量）。我们选择了21个SR和MA，8个RCT，1个非RCT和1个定性研究。在10个试验中，有3个被分类为实时视频，1个被分类为实时视频和音频，4个被分类为异步，2个为联合干预。基于合并的T1DM和T2DM患者数据，HbA1c水平显着下降，加权平均值差异为-0.22％（WMD； 95％CI -0.28至-0.15； T1DM患者的PP1c值可能明显小于T2DM患者。对血压，体重，FBG，成本效益的影响，与HbA1c相比，节省时间更小，但在某些出版物中显示出潜力。结论：远程医疗干预措施可能在整体上改善糖尿病控制方面具有临床效果，并且可能显着改善HbA1c的浓度。在降低HbA1c水平方面，T2DM患者可能比T1DM患者受益更多。持续时间更长，队列更大的进一步研究是必要的。

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