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Konnyu KJ, Yogasingam S, Lépine J, Sullivan K, Alabousi M, Edwards A, Hillmer M, Karunananthan S, Lavis JN, Linklater S, Manns BJ, Moher D, Mortazhejri S, Nazarali S, Paprica PA, Ramsay T, Ryan PM, Sargious P, Shojania KG, Straus SE, Tonelli M, Tricco A, Vachon B, Yu CH, Zahradnik M, Trikalinos TA, Grimshaw JM, Ivers N. Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes. Cochrane Database Syst Rev 2023; 5:CD014513. [PMID: 37254718 PMCID: PMC10233616 DOI: 10.1002/14651858.cd014513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision-makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations. OBJECTIVES To update existing systematic reviews of diabetes QI programmes and apply novel meta-analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care. SEARCH METHODS We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top-up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section. SELECTION CRITERIA We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system- or provider-targeted QI strategy alone or in combination with a patient-targeted strategy. - System-targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). - Provider-targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). - Patient-targeted: patient education (PE); promotion of self-management (PSM); patient reminders (PR). Patient-targeted QI strategies needed to occur with a minimum of one provider or system-targeted strategy. DATA COLLECTION AND ANALYSIS We dual-screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta-regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outcomes. To explore this further, we extended the main additive model for continuous outcomes (HbA1c, SBP and LDL-C) to include an interaction term between each strategy and average baseline risk for each study (baseline thresholds were based on a data-driven approach; we used the median of all baseline values reported in the trials). Based on model diagnostics, the baseline interaction models for HbA1c, SBP and LDL-C performed better than the main model and are therefore presented as the primary analyses for these outcomes. Based on the model results, we qualitatively ordered each QI strategy within three tiers (Top, Middle, Bottom) based on its magnitude of effect relative to the other QI strategies, where 'Top' indicates that the QI strategy was likely one of the most effective strategies for that specific outcome. Secondary analyses explored the sensitivity of results to choices in model specification and priors. Additional information about the methods and results of the review are available as Appendices in an online repository. This review will be maintained as a living systematic review; we will update our syntheses as more data become available. MAIN RESULTS We identified 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412,161 participants. Of the included studies, 66% involved people living with type 2 diabetes only. Participants were 50% female and the median age of participants was 58.4 years. The mean duration of follow-up was 12.5 months. HbA1c was the commonest reported outcome; screening outcomes and outcomes related to cardiovascular medications, smoking and harms were reported infrequently. The most frequently evaluated QI strategies across all study arms were PE, PSM and CM, while the least frequently evaluated QI strategies included AF, FI and CQI. Our confidence in the evidence is limited due to a lack of information on how studies were conducted. Four QI strategies (CM, TC, PE, PSM) were consistently identified as 'Top' across the majority of outcomes. All QI strategies were ranked as 'Top' for at least one key outcome. The majority of effects of individual QI strategies were modest, but when used in combination could result in meaningful population-level improvements across the majority of outcomes. The median number of QI strategies in multicomponent QI programmes was three. Combinations of the three most effective QI strategies were estimated to lead to the below effects: - PR + PSM + CE: decrease in HbA1c by 0.41% (credibility interval (CrI) -0.61 to -0.22) when baseline HbA1c < 8.3%; - CM + PE + EPR: decrease in HbA1c by 0.62% (CrI -0.84 to -0.39) when baseline HbA1c > 8.3%; - PE + TC + PSM: reduction in SBP by 2.14 mmHg (CrI -3.80 to -0.52) when baseline SBP < 136 mmHg; - CM + TC + PSM: reduction in SBP by 4.39 mmHg (CrI -6.20 to -2.56) when baseline SBP > 136 mmHg; - TC + PE + CM: LDL-C lowering of 5.73 mg/dL (CrI -7.93 to -3.61) when baseline LDL < 107 mg/dL; - TC + CM + CR: LDL-C lowering by 5.52 mg/dL (CrI -9.24 to -1.89) when baseline LDL > 107 mg/dL. Assuming a baseline screening rate of 50%, the three most effective QI strategies were estimated to lead to an absolute improvement of 33% in retinopathy screening (PE + PR + TC) and 38% absolute increase in foot screening (PE + TC + Other). AUTHORS' CONCLUSIONS There is a significant body of evidence about QI programmes to improve the management of diabetes. Multicomponent QI programmes for diabetes care (comprised of effective QI strategies) may achieve meaningful population-level improvements across the majority of outcomes. For health system decision-makers, the evidence summarised in this review can be used to identify strategies to include in QI programmes. For researchers, this synthesis identifies higher-priority QI strategies to examine in further research regarding how to optimise their evaluation and effects. We will maintain this as a living systematic review.
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Affiliation(s)
- Kristin J Konnyu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sharlini Yogasingam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Johanie Lépine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Alun Edwards
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael Hillmer
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sathya Karunananthan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - John N Lavis
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Stefanie Linklater
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Braden J Manns
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sameh Mortazhejri
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Samir Nazarali
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - P Alison Paprica
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Timothy Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Peter Sargious
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Kaveh G Shojania
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Marcello Tonelli
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Andrea Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
- Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Occupational Therapy Program, University of Montreal, Montreal, Canada
| | - Catherine Hy Yu
- Department of Medicine, St. Michael's Hospital, Toronto, Canada
| | - Michael Zahradnik
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Thomas A Trikalinos
- Departments of Health Services, Policy, and Practice and Biostatistics, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
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Udsen FW, Hangaard S, Bender C, Andersen J, Kronborg T, Vestergaard P, Hejlesen O, Laursen S. The Effectiveness of Telemedicine Solutions in Type 1 Diabetes Management: A Systematic Review and Meta-analysis. J Diabetes Sci Technol 2022; 17:782-793. [PMID: 35135365 DOI: 10.1177/19322968221076874] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Telemedicine holds a potential to strengthen self-management support outside health care settings in the everyday management of type 1 diabetes (T1D). However, existing effectiveness reviews are older or include a relatively narrow focus on specific definitions of telemedicine or included databases. OBJECTIVE To conduct a systematic review of the effectiveness of telemedicine solutions versus any comparator on diabetes-related outcomes among people with T1D. METHODS Studies including adults (≥18 years) with T1D published before October 14, 2020, were eligible. Primary outcome was glycated hemoglobin (HbA1c, %). The Cochrane Library, PubMed, EMBASE, and CINAHL were searched. Meta-analysis based on the mean difference in HbA1c% was used to pool effects. The Cochrane tool was applied to assess risk-of-bias, and the certainty of evidence was graded using the GRADE approach. RESULTS A total of 22 studies were included (with 1615 participants). Treatment effect for HbA1c% favored telemedicine (mean difference of -0.26% [95% confidence interval:-0.37% to -0.15%]) with moderate effect certainty. Heterogeneity was moderate (I2 = 33.30%). Although not significant, secondary outcomes were all in favor of telemedicine except number of severe hypoglycemic events and diabetes knowledge, but the certainty of the evidence for those outcomes was all low or very low. DISCUSSION Reducing average HbA1c% levels are important to combat the risk of diabetic complications and premature death. However, the evidence mostly consist of small studies with a relative short duration and the estimated pooled effect is smaller than could be expected from quality improvement strategies in general for diabetes management. PROSPERO NUMBER CRD42020123565.
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Affiliation(s)
- Flemming Witt Udsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Clara Bender
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Sisse Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Nursing, University College Nordjylland, Aalborg, Denmark
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3
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Rouf S, Rbiai N, Baibai K, Berrich J, Bouchentouf T, Rahmoun M, Abda N, Latrech H. Feasibility and Efficiency of a Novel Bolus Calculator (IF-DIABETE) for Patients With Type 1 Diabetes: A Nonrandomized Single-Arm Pilot Study. Cureus 2021; 13:e12646. [PMID: 33585132 PMCID: PMC7872867 DOI: 10.7759/cureus.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background The IF-DIABETE system is an insulin bolus dose support, considered as the first bolus calculator dedicated to people with type 1 diabetes, designed in the Arabic language, and adapted to the large Arabic food culture. Our aims were to assess the proof of concept and efficiency of the IF-DIABETE system in improving clinical and metabolic outcomes in individuals with type 1 diabetes. Methods This is a prospective nonrandomized single-arm pilot study. Our patients used the IF-DIABETE smartphone application as a novel bolus calculator. Over six months period of the study, the primary outcome considered was hemoglobin glycated (HbA1c), and we identified hypoglycemic events, body mass index (BMI), and the frequency of blood glucose measurements as secondary outcomes. Results Twenty-one patients with type 1 diabetes were enrolled. The average age was 21 ± 3 years. Over a six months' period of the study, the mean HbA1c level decreased from 8.3 ± 0.8% to 7.0 ± 0.5 % with a reduction in mild hypoglycemic events' frequency from 5 ± 3 to 1 ± 0.7 episodes/3 months. We did not observe any change in BMI and the frequency of the blood glucose testing improved from 2 ± 0.5 to 5 ± 1 tests per day. Conclusion The IF-DIABETE system was safe and effective to support individuals who have type 1 diabetes to improve their metabolic control. At six months, patients were able to improve their glycemic control without increasing the risk of hypoglycemic events.
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Affiliation(s)
- Siham Rouf
- Diabetology and Endocrinology, Mohammed VI University Hospital, Medical School, Mohamed the First University, Oujda, MAR
| | - Najwa Rbiai
- Diabetology and Endocrinology, Mohammed VI University Hospital, Medical School, Mohamed the First University, Oujda, MAR
| | - Kaoutar Baibai
- Research Laboratory in Applied Sciences, National School of Applied Sciences, Mohamed the First University, Oujda, MAR
| | - Jamal Berrich
- Research Laboratory in Applied Sciences, National School of Applied Sciences, Mohamed the First University, Oujda, MAR
| | - Toumi Bouchentouf
- Research Laboratory in Applied Sciences, National School of Applied Sciences, Mohamed the First University, Oujda, MAR
| | - Mohammed Rahmoun
- Research Laboratory in Applied Sciences, National School of Applied Sciences, Mohamed the First University, Oujda, MAR
| | - Naima Abda
- Laboratory of Epidemiology, Clinical Research and Public Health, Mohammed the First University, Oujda, MAR
| | - Hanane Latrech
- Diabetology and Endocrinology, Mohammed VI University Hospital, Medical School, Mohamed the First University, Oujda, MAR
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Gomez-Peralta F, Abreu C, Gomez-Rodriguez S, Cruz-Bravo M, María-Sanchez C, Poza G, Ruiz-Valdepeñas L. Efficacy of Insulclock in Patients with Poorly Controlled Type 1 Diabetes Mellitus: A Pilot, Randomized Clinical Trial. Diabetes Technol Ther 2020; 22:686-690. [PMID: 32069067 PMCID: PMC7640744 DOI: 10.1089/dia.2019.0427] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Insulclock® is an electronic device designed to improve treatment adherence and insulin injection tracking. This randomized, single-center, pilot study assessed the clinical impact of Insulclock on glycemic control and variability, treatment adherence, and satisfaction in patients with uncontrolled type 1 diabetes mellitus (T1DM). We also compared these outcomes between the Active and Masked groups (with or without receiving reminders and app alerts). Sixteen patients completed the study: 10 in the Active group and 6 in the Masked group. Insulclock use was associated with a decrease in mean glucose (-27.0 mg/dL [1.5 mmol/L]; P = 0.013), glucose standard deviation (-14.4 mg/dL [0.8 mmol/L]; P = 0.003), and time above range (-12.5%; P = 0.0026), and an increase in time in range (TIR) (+7%; P = 0.038) in the overall population. The use of app information and alerts in the Active group was associated with an increase in TIR (+8%; P = 0.026). We observed a -3.9 (P = 0.1352) and -5.4 (P = 0.032) reduction per month in the number of missed and mistimed insulin doses in the overall population, respectively. Most of the items of the Insulin Treatment Satisfaction Questionnaire (ITSQ) improved after 4 weeks of Insulclock use. This pilot study points out an improvement in glycemic levels, adherence, and satisfaction in T1DM patients, supporting the development of clinical trials powered to confirm these effects.
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Affiliation(s)
- Fernando Gomez-Peralta
- Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia, Spain
- Address correspondence to: Dr. Fernando Gomez-Peralta, MD, PhD, Endocrinology and Nutrition Unit, Segovia General Hospital, Luis Erik Clavería Neurólogo S.N., 40002 Segovia, Spain
| | - Cristina Abreu
- Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia, Spain
| | | | | | | | - Gema Poza
- Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia, Spain
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Chan C, Sounderajah V, Acharya A, Normahani P, Bicknell C, Riga C. The Role of Wearable Technologies and Telemonitoring in Managing Vascular Disease. VASCULAR AND ENDOVASCULAR REVIEW 2020. [DOI: 10.15420/ver.2019.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Wearable devices and telemonitoring are becoming increasingly widespread in the clinical environment and have many applications in the tracking and maintenance of patient wellbeing. Interventions incorporating these technologies have been used with some success in patients with vascular disorders. Wearable fitness monitors and telemonitoring have been used in the community to mobilise patients with peripheral vascular disease with good results. Additionally, wearable monitors and telemonitoring have been studied for blood pressure monitoring in patients with hypertension. Telemonitoring interventions incorporating electronic medication trays and ingestible sensors have also been found to increase drug adherence in hypertensive patients and ultimately improve health outcomes. However, wearable and telemonitoring interventions often face problems with patient adherence, digital literacy and infrastructure. Further work needs to address these challenges and validate the technology before widespread implementation can occur.
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Affiliation(s)
- Calvin Chan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Amish Acharya
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Pasha Normahani
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Colin Bicknell
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Celia Riga
- Department of Surgery and Cancer, Imperial College London, London, UK
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6
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Lemelin A, Godbout A, Paré G, Bernard S. Improved Glycemic Control Through the Use of a Telehomecare Program in Patients with Diabetes Treated with Insulin. Diabetes Technol Ther 2020; 22:243-248. [PMID: 31657625 DOI: 10.1089/dia.2019.0324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: With the drastic surge in the prevalence of diabetes, the use of medical resources for management of diabetic patients increased markedly. This study aimed to evaluate the impact of telehomecare (THC) use on clinical efficacy, nursing interventions, and medical visits compared with the standard care in insulin-treated diabetic patients. Materials and Methods: A prospective noninferiority clinical trial was designed. Participants were assigned to either an intervention group provided with a THC system during 3 months or to a control group. Main outcome was the difference in A1c at 3 months compared with baseline. Secondary outcomes were the difference in A1c at 6 months compared with baseline, the number of medical visits during the 6-month period of the study, and nursing interventions during the 3 months on THC. Results: A total of 92 participants completed the study. A significant decrease in A1c levels was observed in the THC group (n = 45) compared with the control group (n = 47) at 3 months (-0.61% vs. -0.06%, respectively, P = 0.048) and at 6 months (-0.37% vs. -0.10%, respectively, P = 0.036). The THC group had an average of 0.6 medical visit compared with 1.0 in the control group (P < 0.001). An increase in nursing interventions (mainly e-mails) was noted in THC group (n = 14.7) compared with control group (n = 1.1). Conclusions: This THC program demonstrates improvement in glycemic control and a decrease in the number of medical visits. However, it is important to consider an additional burden in nursing interventions when implementing a THC program.
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Affiliation(s)
- Annie Lemelin
- Endocrinology Division, Medicine Department, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Ariane Godbout
- Endocrinology Division, Medicine Department, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Guy Paré
- Research Chair in Digital Health, HEC Montreal, Montreal, Canada
| | - Sophie Bernard
- Endocrinology Division, Medicine Department, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Current address: IRCM, Montreal Research Institute, Montreal, Quebec, Canada
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Andrès E, Meyer L, Zulfiqar AA, Hajjam M, Talha S, Bahougne T, Ervé S, Hajjam J, Doucet J, Jeandidier N, Hajjam El Hassani A. Telemonitoring in diabetes: evolution of concepts and technologies, with a focus on results of the more recent studies. J Med Life 2019; 12:203-214. [PMID: 31666818 PMCID: PMC6814890 DOI: 10.25122/jml-2019-0006] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This is a narrative review of telemonitoring (remote monitoring) projects and studies within the field of diabetes, with a focus on results of the more recent studies. Since the beginning of the 1990s, several telemedicine projects and studies focused on type 1 and type 2 diabetes. Over the last 5 years, numerous telemedicine projects based on connected objects and new information and communication technologies (ICT) (elements defining telemedicine 2.0) have emerged or are still under development. Two examples are the DIABETe and Telesage telemonitoring project which perfectly fits within the telemedicine 2.0 framework – the first to include artificial intelligence (AI) with MyPrediTM and DiabeoTM. Mainly, these projects and studies show that telemonitoring diabetic result in: improvements in control of blood glucose (BG) level and significant reduction in HbA1c (e.g., for Telescot et TELESAGE studies); positive impact on co-morbidities (arterial hypertension, weight, dyslipidemia) (e.g., for Telescot and DIABETe studies); better patient’s quality of life (e.g., for DIABETe study); positive impact on appropriation of the disease by patients and/or greater adherence to therapeutic and hygiene-dietary measures (e.g., The Utah Remote Monitoring Project); and at least, good receptiveness by patients and their empowerment. To date, the magnitude of its effects remains debatable, especially with the variation in patients’ characteristics (e.g., background, ability for self-management, medical condition), samples selection and approach for the treatment of control groups. All of the recent studies have been classified as “Moderate” to “High”.
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Affiliation(s)
- Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, 1, porte de l'Hôpital, 67091 Strasbourg cedex France.,Equipe de recherche EA 3072 «Mitochondrie, Stress oxydant et Protection musculaire», Faculté de Médecine de Strasbourg, Université de Strasbourg (Unistra), Strasbourg, France
| | - Laurent Meyer
- Service d'Endocrinologie et de Diabétologie de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Abrar-Ahmad Zulfiqar
- Equipe de recherche EA 3072 «Mitochondrie, Stress oxydant et Protection musculaire», Faculté de Médecine de Strasbourg, Université de Strasbourg (Unistra), Strasbourg, France.,Service de Médecine Interne, Gériatrie et Thérapeutique, CHU de Rouen, France
| | | | - Samy Talha
- Equipe de recherche EA 3072 «Mitochondrie, Stress oxydant et Protection musculaire», Faculté de Médecine de Strasbourg, Université de Strasbourg (Unistra), Strasbourg, France.,Service de Physiologie et d'Explorations Fonctionnelles, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thibault Bahougne
- Service d'Endocrinologie et de Diabétologie de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sylvie Ervé
- Centre d'expertise des Technologies de l'Information et de la Communication pour l'autonomie (CENTICH) et Mutualité Française Anjou-Mayenne (MFAM), Angers, France
| | - Jawad Hajjam
- Centre d'expertise des Technologies de l'Information et de la Communication pour l'autonomie (CENTICH) et Mutualité Française Anjou-Mayenne (MFAM), Angers, France
| | - Jean Doucet
- Service de Médecine Interne, Gériatrie et Thérapeutique, CHU de Rouen, France
| | - Nathalie Jeandidier
- Service d'Endocrinologie et de Diabétologie de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Amir Hajjam El Hassani
- Equipe de recherche EA 4662 «Nanomédecine, Imagerie, Thérapeutiques», Université de Technologie de Belfort-Montbéliard (UTBM), Belfort-Montbéliard, France
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8
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Odom JM, Stancil M, Nelson B, Russ-Sellers R, Schwecke N, Dawson J, Reulbach LS, Burns A, Lindholm M, Bruch JS. Improving Diabetes Control Through Remote Glucose Monitoring in a Diabetes Self-Management Program for Employees of a Health System. Clin Diabetes 2019; 37:203-210. [PMID: 31371850 PMCID: PMC6640876 DOI: 10.2337/cd18-0056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IN BRIEF This study investigates the combination of diabetes education, telehealth, a wireless enabled meter, and medication algorithms to improve care for a targeted population of employees with type 1 or type 2 diabetes. After more than 2 years of follow-up, mean A1C was reduced by 1.8%, and a reduction was observed in cost of care, along with an increase in visits with the managing physician provider. Thus, this study showed improved diabetes control using new technologies to provide remote monitoring and telehealth augmenting the outreach and education provided in a diabetes self-management program.
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Uysal S, Quintos JB, DerMarderosian D, Chapman HA, Reinert SE, Hirway P, Topor LS. PARTIAL HOSPITALIZATION: AN INTERVENTION FOR YOUTH WITH POORLY CONTROLLED DIABETES MELLITUS. Endocr Pract 2019; 25:1041-1048. [PMID: 31241360 DOI: 10.4158/ep-2019-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To examine the efficacy of an integrated medical/psychiatric partial hospitalization program (PHP) to improve glycemic control in youth with both diabetes mellitus and mental health disorders. Methods: This retrospective chart review is of patients admitted to a PHP between 2005-2015 with concerns about diabetes mellitus care. Clinical characteristics, laboratory data, diabetic ketoacidosis hospitalizations, and outpatient clinic visit frequency were collected from the year prior to the year after PHP admission. Results: A total of 43 individuals met inclusion criteria: 22 (51%) were female, 40 (93%) had type 1 diabetes, the mean age was 15.2 ± 2.3 years, and the mean diabetes mellitus duration was 4.6 ± 3.6 years. Of those individuals, 35 of these patients had hemoglobin A1c (HbA1c) data available at baseline, 6 months, and 1 year after PHP. The average HbA1c before PHP admission was 11.3 ± 2.3% (100.5 ± 25 mmol/mol), and decreased to 9.2 ± 1.3% (76.7 ± 14.8 mmol/mol) within 6 months of PHP admission (P<.001). The average HbA1c 1 year after PHP was 10.7 ± 1.7 % (93.3 ± 19.1 mmol/mol). Overall, 24 patients (68%) had lower HbA1c, and 75% of those with improvement maintained an HbA1c reduction of ≥1% (≥10 mmol/mol) at 1 year compared to before PHP. Conclusion: Most patients demonstrated improved glycemic control within 6 months of PHP admission, and many of those maintained a ≥1% (≥10 mmol/mol) reduction in HbA1c at 1 year following PHP admission. This program may represent a promising intervention that could serve as a model for intensive outpatient management of youth with poorly controlled diabetes mellitus. Abbreviations: ADA = American Diabetes Association; DKA = diabetic ketoacidosis; EMR = electronic medical record; HbA1c = hemoglobin A1c; ICD-9 = International Classification of Diseases, 9th revision; PHP = partial hospitalization program.
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Yaron M, Sher B, Sorek D, Shomer M, Levek N, Schiller T, Gaspar M, Frumkin Ben-David R, Mazor-Aronovitch K, Tish E, Shapira Y, Pinhas-Hamiel O. A randomized controlled trial comparing a telemedicine therapeutic intervention with routine care in adults with type 1 diabetes mellitus treated by insulin pumps. Acta Diabetol 2019; 56:667-673. [PMID: 30783823 DOI: 10.1007/s00592-019-01300-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/11/2019] [Indexed: 02/05/2023]
Abstract
AIM To examine the effectiveness and safety over a 12-month period of a telemedicine intervention in adults with type 1 diabetes (T1D) treated with insulin pumps. METHODS 74 T1D patients on insulin pumps for at least 1 year (mean 19.5 [11.5] years) and HbA1c ≥ 6.5% (≥ 48 mmol/mol) were randomized to the telemedicine (n = 37) or the standard care group (n = 37). The intervention group was instructed to download data from insulin pumps and glucometers monthly. They received immediate phone feedback and recommendations for insulin dose adjustment; and face-to-face visits once in 6 months, compared to once every 3 months for the standard care group. Satisfaction with treatment, quality of life and frequency of hypoglycemic events was evaluated. RESULTS The mean changes in HbA1c adjusted to baseline were - 0.08% (0.25 mmol/mol) vs. - 0.01% (0.03 mmol/mol), in the intervention and control groups, respectively (p = 0.18) at 12 months, without an increased frequency of hypoglycemia. Patients in the intervention group felt satisfied and interested in continuing with the treatment (p = 0.04). The quality of life scores were similar in both groups. Direct total costs were 24% less in the intervention group, and indirect total costs decreased by 22% compared to the year preceding the study. CONCLUSIONS Internet-based insulin dose adjustment is as effective and safe as routine care in adults with type 1 diabetes treated by insulin pumps. For suitable patients, some of the time-consuming routine visits may be replaced by user-friendly digital medicine. CLINICAL TRIAL REGISTRATION Clinical Trial.gov Identifier NCT01887431.
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Affiliation(s)
- Marianna Yaron
- Maccabi National Juvenile Diabetes Center, Raanana, Israel.
- Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Bruria Sher
- Maccabi National Juvenile Diabetes Center, Raanana, Israel
| | - Daniel Sorek
- Maccabi National Juvenile Diabetes Center, Raanana, Israel
| | - Mina Shomer
- Maccabi National Juvenile Diabetes Center, Raanana, Israel
| | - Noa Levek
- Maccabi National Juvenile Diabetes Center, Raanana, Israel
| | - Tali Schiller
- Maccabi National Juvenile Diabetes Center, Raanana, Israel
| | - Monica Gaspar
- Maccabi National Juvenile Diabetes Center, Raanana, Israel
| | | | - Kineret Mazor-Aronovitch
- Maccabi National Juvenile Diabetes Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel
| | - Efrat Tish
- Maccabi National Juvenile Diabetes Center, Raanana, Israel
| | - Yoni Shapira
- Maccabi National Juvenile Diabetes Center, Raanana, Israel
- Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Pinhas-Hamiel
- Maccabi National Juvenile Diabetes Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel
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11
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Salari R, R Niakan Kalhori S, Ghazisaeidi M, Fatehi F. Conformity of Diabetes Mobile apps with the Chronic Care Model. BMJ Health Care Inform 2019; 26:bmjhci-2019-000017. [PMID: 31039125 PMCID: PMC7062315 DOI: 10.1136/bmjhci-2019-000017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2019] [Indexed: 11/15/2022] Open
Abstract
Background Despite the growing use of mobile applications (apps) for chronic disease management, the evidence on the effectiveness of this technology on clinical and behavioural outcomes of the patients is scant. Many studies highlight the importance of the theoretical foundations of mobile-based interventions. One of the most widely accepted models for the management of chronic diseases, such as diabetes, is the Chronic Care Model (CCM). In this study, we investigated the conformity of the selected diabetes mobile apps with CCM. Method We searched online journal databases related to diabetes mobile apps to find common features. Then considering the components of the CCM as a reference model, features of some popular and top-ranking apps were compared with CCM. Results Among 23 studied apps, 34 per cent of them had medium conformity and 66 per cent of these apps were in weak conformity. The self-management support component is covered by 100 per cent of them. Ninety-five per cent of apps have covered the proactive follow-up component. Conclusions App conformance with CCM is generally weak. App developers are recommended to give greater consideration to established theoretical models in their design and implementation.
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Affiliation(s)
- Raheleh Salari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Science, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Science, Tehran, Iran
| | - Marjan Ghazisaeidi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Science, Tehran, Iran
| | - Farhad Fatehi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Science, Tehran, Iran.,Australian eHealth Research Centre, CSIRO, Brisbane, Queensland, Australia.,Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
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12
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Wang X, Shu W, Du J, Du M, Wang P, Xue M, Zheng H, Jiang Y, Yin S, Liang D, Wang R, Hou L. Mobile health in the management of type 1 diabetes: a systematic review and meta-analysis. BMC Endocr Disord 2019; 19:21. [PMID: 30760280 PMCID: PMC6375163 DOI: 10.1186/s12902-019-0347-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/25/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND As an insulin-dependent disease, type 1 diabetes requires paying close attention to the glycemic control. Studies have shown that mobile health (mHealth) can improve the management of chronic diseases. However, the effectiveness of mHealth in controlling the glycemic control remains uncertain. The objective of this study was to carry out a systematic review and meta-analysis using the available literature reporting findings on mHealth interventions, which may improve the management of type 1 diabetes. METHODS We performed a systematic literature review of all studies in the PubMed, Web of Science, and EMbase databases that used mHealth (including mobile phones) in diabetes care and reported glycated hemoglobin (HbA1c) values as a measure of glycemic control. The fixed effects model was used for this meta-analysis. RESULTS This study analyzed eight studies, which involved a total of 602 participants. In the meta-analysis, the fixed effects model showed a statistically significant decrease in the mean of HbA1c in the intervention group: - 0.25 (95% confidence interval: - 0.41, - 0.09; P = 0.003, I2 = 12%). Subgroup analyses indicated that the patient's age, the type of intervention, and the duration of the intervention influenced blood glucose control. Funnel plots showed no publication bias. CONCLUSIONS Mobile health interventions may be effective among patients with type 1 diabetes. A significant reduction in HbA1c levels was associated with adult age, the use of a mobile application, and the long-term duration of the intervention.
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Affiliation(s)
- Xuemei Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, 100191 China
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110 China
| | - Wei Shu
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110 China
- Clinical Center on TB Control, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, 101149 China
| | - Jian Du
- Clinical Center on TB Control, Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital, Capital Medical University, Beijing, 101149 China
| | - Maolin Du
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110 China
| | - Peiyu Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, 100191 China
| | - Mingming Xue
- School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010110 China
| | - Huiqiu Zheng
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110 China
| | - Yufeng Jiang
- Diabetes Centre, The 306th Hospital of PLA, Beijing, 100101 China
| | - Shaohua Yin
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110 China
| | - Danyan Liang
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110 China
| | - Ruiqi Wang
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110 China
| | - Lina Hou
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110 China
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13
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Mise au point sur les projets de recherche dans le domaine de la télémédecine dans le diabète, avec un focus sur les projets de télésurveillance 2.0. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1957-2557(19)30027-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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14
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Chew LC, Xin X, Yang H, Thumboo J. An evaluation of the Virtual Monitoring Clinic, a novel nurse-led service for monitoring patients with stable rheumatoid arthritis. Int J Rheum Dis 2018; 22:619-625. [PMID: 30450812 DOI: 10.1111/1756-185x.13436] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/13/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To study clinical and patient reported outcomes for the Virtual Monitoring Clinic (VMC), a remote nurse-led telemonitoring service for monitoring Rheumatoid Arthritis (RA) patients treated with disease-modifying antirheumatic drugs (DMARDs). METHODS Patients with stable RA enrolled in the VMC were followed up prospectively. The primary outcomes evaluated at 1-year follow-up were: Disease Activity Score-28 (DAS28), Routine Assessment of Patient Index Data 3 (RAPID3), and patient satisfaction assessed using an 11-point Likert scale. RESULTS Of the 251 patients enrolled, 186 completed 1-year of follow-up. There was a 2.3% (n = 450) reduction in the annual workload from the rheumatology specialist outpatient clinic as a result of the VMC. Statistically significant improvement was seen in the mean patient satisfaction score (7.70-8.16, P ≤ 0.001), with 61.5% of patients opting for the VMC alternating with rheumatology outpatient clinic visits as their preferred mode of follow-up vis-à-vis standard care. There was a marginal increase in mean DAS28 and RAPID3 scores from 2.56 to 2.78 (P < 0.05) and 5.28 to 6.03 (P < 0.05), respectively. However, given that at 1-year follow-up more than half (72.0% and 63.4% based on DAS28 and RAPID3) of the patients' disease activity had improved or remained stable, and was in remission or low activity (73.1% and 53.2% based on DAS28 and RAPID3), the VMC seemed to maintain a stable RA disease activity for the majority of patients. CONCLUSIONS The VMC is an effective and well-accepted novel approach for the management of patients with stable RA.
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Affiliation(s)
- Li-Ching Chew
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,DukeNUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xiaohui Xin
- Medicine Academic Clinical Programme, Singapore General Hospital, Singapore, Singapore
| | - Hui Yang
- Medicine Academic Clinical Programme, Singapore General Hospital, Singapore, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,DukeNUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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15
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Tchero H, Kangambega P, Briatte C, Brunet-Houdard S, Retali GR, Rusch E. Clinical Effectiveness of Telemedicine in Diabetes Mellitus: A Meta-Analysis of 42 Randomized Controlled Trials. Telemed J E Health 2018; 25:569-583. [PMID: 30124394 DOI: 10.1089/tmj.2018.0128] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Telemedicine is instrumental in improving diabetes patient care, as well as providing significant cost benefits. This meta-analysis was conducted to compare the effectiveness of telemedicine intervention with usual care in diabetes patients. Methods: Randomized controlled trials (RCTs) reporting a change in HbA1c after usual care and telemedicine intervention were retrieved from electronic databases. Results: Data on 6,170 participants (mean age 13.3 to 71.0 years), with 3,128 randomized to usual care and 3,042 to telemedicine intervention, were retrieved from 42 RCTs. Eight studies used teleconsultation, while 34 used telemonitoring (device based). Nine studies enrolled both type 1 and type 2 diabetes patients, 21 focused on type 2 diabetes patients, and 12 on type 1 diabetes patients. The mean reduction in HbA1c was significantly higher in the telemedicine groups (Hedges' g = -0.37, p < 0.001). Type 2 diabetes patients experienced a higher reduction in HbA1c compared to type 1 diabetes patients (Hedges' g = -0.48, p < 0.001 vs. -0.26, p < 0.05; Q = 1935.75, p < 0.0001). Older patients (41-50 years, Hedges' g = -1.82, p < 0.001; >50 years, Hedges' g = -1.05, p < 0.001) benefited more than their younger counterparts (Hedges' g = -0.84, p = 0.07). Telemedicine programs lasting >6 months produced a significantly greater reduction in HbA1c levels (Hedges' g = -2.24 vs. -0.66, p < 0.001). Conclusion: Telemedicine interventions are more effective than usual care in managing diabetes, especially type 2 diabetes. Furthermore, older patients and a longer duration of intervention provide superior results.
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Affiliation(s)
- Huidi Tchero
- 1 Department of Trauma and Orthopedics Surgery and Wound Healing Unit, Saint Martin, Guadeloupe, France
- 2 CHU de Tours-SIMEES-Medico-Economic Evaluation Unit, Tours Area, France
| | - Pauline Kangambega
- 3 Division of Diabetes, Endocrinology and Metabolism, CHRU de Pointe-A-Pitre, Pointe-A-Pitre, Guadeloupe, France
| | - Christine Briatte
- 4 Regional Health Agency Guadeloupe, Saint-Martin et Saint-Barthélemy, Guadeloupe, France
| | | | | | - Emmanuel Rusch
- 2 CHU de Tours-SIMEES-Medico-Economic Evaluation Unit, Tours Area, France
- 6 Department of Medical Information and Public Health, University Hospital, Tours, France
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16
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Ayatollahi H, Hasannezhad M, Fard HS, Haghighi MK. Type 1 diabetes self-management: developing a web-based telemedicine application. HEALTH INF MANAG J 2018; 45:16-26. [PMID: 28691565 DOI: 10.1177/1833358316639456] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Self-management skills are essential for patients with diabetes mellitus to minimise the risks of complications from their condition. The aim of this research was to develop a web-based application for self-management of type 1 diabetes, suitable for use by patients, their carers and physicians. METHOD The study was comprised of two phases, the first being analysis of the kind of information and capabilities required by potential users of the system. Based on the results derived from the first phase of the study, the system prototype was designed and then evaluated using the 'think aloud' method and a standard questionnaire. The application was designed for use by patients, their carers and physicians. Patients could enter the level of blood glucose, insulin and activities on a daily basis, and physicians were able to supervise a patient's health status from a distance. RESULTS Users were generally satisfied with the final version of the system. People with a wide range of literacy skills were able to use the system effectively. CONCLUSION Patients or their carers could use the web-based application as a log book by entering the level of blood glucose and insulin doses on a regular basis, and as an educational resource to improve self-management skills. Physicians could use the system at any time convenient to them to support patients by giving medical advice. Further research is needed to report the effectiveness of the system in practice.
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Affiliation(s)
- Haleh Ayatollahi
- 1 Department of Health Information Management, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hasannezhad
- 1 Department of Health Information Management, Iran University of Medical Sciences, Tehran, Iran
| | - Hedieh Saneei Fard
- 2 Paediatric Endocrinology & Metabolism, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Kamkar Haghighi
- 1 Department of Health Information Management, Iran University of Medical Sciences, Tehran, Iran
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17
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Accuracy of Automatic Carbohydrate, Protein, Fat and Calorie Counting Based on Voice Descriptions of Meals in People with Type 1 Diabetes. Nutrients 2018; 10:nu10040518. [PMID: 29690520 PMCID: PMC5946303 DOI: 10.3390/nu10040518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/11/2018] [Accepted: 04/19/2018] [Indexed: 11/16/2022] Open
Abstract
The aim of this work was to assess the accuracy of automatic macronutrient and calorie counting based on voice descriptions of meals provided by people with unstable type 1 diabetes using the developed expert system (VoiceDiab) in comparison with reference counting made by a dietitian, and to evaluate the impact of insulin doses recommended by a physician on glycemic control in the study’s participants. We also compared insulin doses calculated using the algorithm implemented in the VoiceDiab system. Meal descriptions were provided by 30 hospitalized patients (mean hemoglobin A1c of 8.4%, i.e., 68 mmol/mol). In 16 subjects, the physician determined insulin boluses based on the data provided by the system, and in 14 subjects, by data provided by the dietitian. On one hand, differences introduced by patients who subjectively described their meals compared to those introduced by the system that used the average characteristics of food products, although statistically significant, were low enough not to have a significant impact on insulin doses automatically calculated by the system. On the other hand, the glycemic control of patients was comparable regardless of whether the physician was using the system-estimated or the reference content of meals to determine insulin doses.
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18
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Bertuzzi F, Stefani I, Rivolta B, Pintaudi B, Meneghini E, Luzi L, Mazzone A. Teleconsultation in type 1 diabetes mellitus (TELEDIABE). Acta Diabetol 2018; 55:185-192. [PMID: 29209814 DOI: 10.1007/s00592-017-1084-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/22/2017] [Indexed: 01/24/2023]
Abstract
AIMS The growing incidence of diabetes and the need to contain healthcare costs empower the necessity to identify new models of care. Telemedicine offers an acknowledged instrument to provide clinical health care at a distance, increasing patient compliance and the achievement of therapeutical goals. The objective was to test the feasibility and the efficacy in the improvement of the glycemic control of the teleconsultation for patients with type 1 diabetes mellitus. METHODS A randomized open-label, parallel arms, controlled trial was conducted in two diabetes centers in Italy. Participants affected by type 1 diabetes mellitus have been randomly (1:1) assigned to receive their visits as standard or a web-based care. Patients in the teleconsultation group can arrange their appointments on a Web site and can also have access to web educational courses or to nutritional and psychological counseling. The primary outcome was the assessment of glycemic control by HbA1c measurement after a 12-month follow-up. RESULTS Overall 74 participants were followed for 1 year. HbA1c changes were not statistically different within (p = 0.56 for standard care group; p = 0.45 for telemedicine group) and between (p = 0.60) groups when considering differences from baseline to the end of the study. Patients randomized to teleconsultation reported reduced severe hypoglycemic episodes (p = 0.03). In addition, they were largely satisfied with the activities, perceived a good improvement in the self-management of the diabetes, and reported to have a time saving and a cost reduction. CONCLUSIONS In conclusion, TELEDIABE proposes a new system for the management of patients with type 1 diabetes mellitus.
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Affiliation(s)
- Federico Bertuzzi
- Diabetology Unit, ASST Grande Ospedale Metropolitano Niguarda, P.zza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Ilario Stefani
- Medicine Department, Legnano ASST Ovest Milanese, Legnano, Italy
| | | | - Basilio Pintaudi
- Diabetology Unit, ASST Grande Ospedale Metropolitano Niguarda, P.zza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Elena Meneghini
- SS Diabetologia, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Livio Luzi
- Metabolism Research Center and Endocrinology and Metabolism, IRCCS Policlinico San Donato Milanese, Milan, Italy
- Department of Biomedical and Health Sciences, University of Milan, Milan, Italy
| | - Antonino Mazzone
- Medicine Department, Legnano ASST Ovest Milanese, Legnano, Italy
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Lawrenson JG, Graham‐Rowe E, Lorencatto F, Burr J, Bunce C, Francis JJ, Aluko P, Rice S, Vale L, Peto T, Presseau J, Ivers N, Grimshaw JM. Interventions to increase attendance for diabetic retinopathy screening. Cochrane Database Syst Rev 2018; 1:CD012054. [PMID: 29333660 PMCID: PMC6491139 DOI: 10.1002/14651858.cd012054.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite evidence supporting the effectiveness of diabetic retinopathy screening (DRS) in reducing the risk of sight loss, attendance for screening is consistently below recommended levels. OBJECTIVES The primary objective of the review was to assess the effectiveness of quality improvement (QI) interventions that seek to increase attendance for DRS in people with type 1 and type 2 diabetes.Secondary objectives were:To use validated taxonomies of QI intervention strategies and behaviour change techniques (BCTs) to code the description of interventions in the included studies and determine whether interventions that include particular QI strategies or component BCTs are more effective in increasing screening attendance;To explore heterogeneity in effect size within and between studies to identify potential explanatory factors for variability in effect size;To explore differential effects in subgroups to provide information on how equity of screening attendance could be improved;To critically appraise and summarise current evidence on the resource use, costs and cost effectiveness. SEARCH METHODS We searched the Cochrane Library, MEDLINE, Embase, PsycINFO, Web of Science, ProQuest Family Health, OpenGrey, the ISRCTN, ClinicalTrials.gov, and the WHO ICTRP to identify randomised controlled trials (RCTs) that were designed to improve attendance for DRS or were evaluating general quality improvement (QI) strategies for diabetes care and reported the effect of the intervention on DRS attendance. We searched the resources on 13 February 2017. We did not use any date or language restrictions in the searches. SELECTION CRITERIA We included RCTs that compared any QI intervention to usual care or a more intensive (stepped) intervention versus a less intensive intervention. DATA COLLECTION AND ANALYSIS We coded the QI strategy using a modification of the taxonomy developed by Cochrane Effective Practice and Organisation of Care (EPOC) and BCTs using the BCT Taxonomy version 1 (BCTTv1). We used Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital (PROGRESS) elements to describe the characteristics of participants in the included studies that could have an impact on equity of access to health services.Two review authors independently extracted data. One review author entered the data into Review Manager 5 and a second review author checked them. Two review authors independently assessed risks of bias in the included studies and extracted data. We rated certainty of evidence using GRADE. MAIN RESULTS We included 66 RCTs conducted predominantly (62%) in the USA. Overall we judged the trials to be at low or unclear risk of bias. QI strategies were multifaceted and targeted patients, healthcare professionals or healthcare systems. Fifty-six studies (329,164 participants) compared intervention versus usual care (median duration of follow-up 12 months). Overall, DRS attendance increased by 12% (risk difference (RD) 0.12, 95% confidence interval (CI) 0.10 to 0.14; low-certainty evidence) compared with usual care, with substantial heterogeneity in effect size. Both DRS-targeted (RD 0.17, 95% CI 0.11 to 0.22) and general QI interventions (RD 0.12, 95% CI 0.09 to 0.15) were effective, particularly where baseline DRS attendance was low. All BCT combinations were associated with significant improvements, particularly in those with poor attendance. We found higher effect estimates in subgroup analyses for the BCTs 'goal setting (outcome)' (RD 0.26, 95% CI 0.16 to 0.36) and 'feedback on outcomes of behaviour' (RD 0.22, 95% CI 0.15 to 0.29) in interventions targeting patients, and 'restructuring the social environment' (RD 0.19, 95% CI 0.12 to 0.26) and 'credible source' (RD 0.16, 95% CI 0.08 to 0.24) in interventions targeting healthcare professionals.Ten studies (23,715 participants) compared a more intensive (stepped) intervention versus a less intensive intervention. In these studies DRS attendance increased by 5% (RD 0.05, 95% CI 0.02 to 0.09; moderate-certainty evidence).Fourteen studies reporting any QI intervention compared to usual care included economic outcomes. However, only five of these were full economic evaluations. Overall, we found that there is insufficient evidence to draw robust conclusions about the relative cost effectiveness of the interventions compared to each other or against usual care.With the exception of gender and ethnicity, the characteristics of participants were poorly described in terms of PROGRESS elements. Seventeen studies (25.8%) were conducted in disadvantaged populations. No studies were carried out in low- or middle-income countries. AUTHORS' CONCLUSIONS The results of this review provide evidence that QI interventions targeting patients, healthcare professionals or the healthcare system are associated with meaningful improvements in DRS attendance compared to usual care. There was no statistically significant difference between interventions specifically aimed at DRS and those which were part of a general QI strategy for improving diabetes care. This is a significant finding, due to the additional benefits of general QI interventions in terms of improving glycaemic control, vascular risk management and screening for other microvascular complications. It is likely that further (but smaller) improvements in DRS attendance can also be achieved by increasing the intensity of a particular QI component or adding further components.
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Affiliation(s)
- John G Lawrenson
- City University of LondonCentre for Applied Vision Research, School of Health SciencesNorthampton SquareLondonUKEC1V 0HB
| | - Ella Graham‐Rowe
- City University LondonSchool of Health Sciences, Centre for Health Services ResearchNorthampton SquareLondonUKEC1V 0HB
| | - Fabiana Lorencatto
- City University LondonSchool of Health Sciences, Centre for Health Services ResearchNorthampton SquareLondonUKEC1V 0HB
| | - Jennifer Burr
- University of St AndrewsSchool of Medicine, Medical and Biological Sciences BuildingFifeUKKY16 9TF
| | - Catey Bunce
- Kings College LondonDepartment of Primary Care & Public Health Sciences4th Floor, Addison HouseGuy's CampusLondonUKSE1 1UL
| | - Jillian J Francis
- City University LondonSchool of Health Sciences, Centre for Health Services ResearchNorthampton SquareLondonUKEC1V 0HB
| | - Patricia Aluko
- Newcastle UniversityNational Institute for Health Research (NIHR) Innovation ObservatoryTimes Central offices, 4th Floor, GallowgateNewcastle upon TyneUKNE1 4BF
| | - Stephen Rice
- Newcastle UniversityInstitute of Health & SocietyNewcastle upon TyneUKNE2 4AX
| | - Luke Vale
- Newcastle UniversityInstitute of Health & SocietyNewcastle upon TyneUKNE2 4AX
| | - Tunde Peto
- Queen's University BelfastCentre for Public HealthBelfastUKBT12 6BA
| | - Justin Presseau
- Ottawa Hospital Research InstituteClinical Epidemiology Program501 Smyth RoadOttawaOntarioCanadaK1H 8L6
| | - Noah Ivers
- Women's College HospitalDepartment of Family and Community Medicine76 Grenville StreetTorontoONCanadaM5S 1B2
| | - Jeremy M Grimshaw
- Ottawa Hospital Research InstituteClinical Epidemiology Program501 Smyth RoadOttawaOntarioCanadaK1H 8L6
- University of OttawaDepartment of MedicineOttawaONCanada
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Kotsani K, Antonopoulou V, Kountouri A, Grammatiki M, Rapti E, Karras S, Trakatelli C, Tsaklis P, Kazakos K, Kotsa K. The role of telenursing in the management of Diabetes Type 1: A randomized controlled trial. Int J Nurs Stud 2018; 80:29-35. [PMID: 29353709 DOI: 10.1016/j.ijnurstu.2018.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 12/27/2017] [Accepted: 01/05/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Diabetes Mellitus type 1 (T1DM) is a chronic disease that requires patients' self-monitoring and self-management to achieve glucose targets and prevent complications. Telenursing implicates technology in the interaction of a specialized nurse with patients with chronic diseases in order to provide personalized care and support. OBJECTIVE To evaluate the effect of telenursing on T1DM patients' compliance with glucose self-monitoring and glycemic control. DESIGN Randomized controlled study. SETTINGS Outpatient Department of Diabetes, Endocrinology and Metabolism of a University Hospital in Northern Greece. METHODS Ninety-four T1DM patients were recruited and randomized in two groups by a random number generator. The intervention group (N = 48) was provided with telenursing services. A specialized nurse made a weekly contact via telephone motivating patients to frequently measure blood glucose and adopt a healthy lifestyle. The control group (N = 46) received standard diabetes advice and care in the clinic. The primary outcome was the effect of the intervention in glucose control and glucose variability. The secondary outcome was the effect on frequency of self-monitoring. SPSS 20.0 was used for data analysis. RESULTS The two groups did not differ in age, sex, physical activity or initial HbA1c. In the intervention group, blood glucose significantly decreased at the end of the study in all predefined measurements, compared to control group: morning (93.18 ± 13.30 mg/dl vs. 105.17 ± 13.74 mg/dl, p < 0.005), pre-prandial (114.76 ± 9.54 mg/dl vs. 120.84 ± 4.05 mg/dl, p < 0.005), post-prandial (193.35 ± 25.36 mg/dl vs. 207.84 ± 18.80 mg/dl, p < 0.005), and HbA1c decreased significantly over time in the intervention group (8.3 ± 0.6% at the beginning of the study vs. 7.8 ± 1% at the end of the study, p = 0.03). In the intervention group there were also fewer omitted glucose measurements than in the control group. CONCLUSIONS Patients in the intervention group achieved better glucose control and more frequent self-monitoring than patients in routine care in the clinic. The findings of our study indicate that telenursing can motivate T1DM patients to better control their disease.
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Affiliation(s)
- Konstantia Kotsani
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Vasiliki Antonopoulou
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Aikaterini Kountouri
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria Grammatiki
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Eleni Rapti
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Spyridon Karras
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Christina Trakatelli
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Panagiotis Tsaklis
- Department of Nursing, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece
| | - Kiriakos Kazakos
- Department of Nursing, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece
| | - Kalliopi Kotsa
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece.
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21
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Lee SWH, Ooi L, Lai YK. Telemedicine for the Management of Glycemic Control and Clinical Outcomes of Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Front Pharmacol 2017; 8:330. [PMID: 28611672 PMCID: PMC5447671 DOI: 10.3389/fphar.2017.00330] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/16/2017] [Indexed: 12/31/2022] Open
Abstract
Importance: Telemedicine has been shown to be an efficient and effective means of providing care to patients with chronic disease especially in remote and undeserved regions, by improving access to care and reduce healthcare cost. However, the evidence surrounding its applicability in type 1 diabetes remains scarce and conflicting. Objective: To synthesize evidence and quantify the effectiveness of telemedicine interventions for the management of glycemic and clinical outcomes in type 1 diabetes patients, relative to comparator conditions. Data Sources: MEDLINE, EMBASE, Cochrane Library, Web of Science, PsycINFO, and CINAHL were searched for published articles since inception until December 2016. Study Selection: Original articles reporting the results of randomized controlled studies on the effectiveness of telemedicine in people with type 1 diabetes were included. Data Extraction and Synthesis: Two reviewers independently extracted data, assessed quality, and strength of evidence. Interventions were categorized based upon the telemedicine focus (monitoring, education, consultation, case-management, and peer mentoring). Main Outcome and Measure: Absolute change in glycosylated hemoglobin A1c (HbA1c) from baseline to follow-up assessment. Results: A total of 38 studies described in 41 articles were identified. Positive effects on glycemic control were noted with studies examining telemedicine, with a mean reduction of 0.18% at the end of intervention. Studies with longer duration (>6 months) who had recruited patients with a higher baseline HbA1c (≥9%) were associated with larger effects. Telemedicine interventions that involve individualized assessments, audit with feedback and skill building were also more effective in improving glycemic control. However, no benefits were observed on blood pressure, lipids, weight, quality of life, and adverse events. Conclusions and Relevance: There is insufficient evidence to support telemedicine use for glycemic control and other clinically relevant outcome among patients with type 1 diabetes.
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Affiliation(s)
- Shaun W H Lee
- School of Pharmacy, Monash University MalaysiaBandar Sunway, Malaysia
| | - Leanne Ooi
- School of Pharmacy, Monash University MalaysiaBandar Sunway, Malaysia
| | - Yin K Lai
- Faculty of Pharmacy, UCSI UniversityKuala Lumpur, Malaysia
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22
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Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer. J Med Internet Res 2017; 19:e172. [PMID: 28526671 PMCID: PMC5451641 DOI: 10.2196/jmir.6688] [Citation(s) in RCA: 312] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 12/28/2022] Open
Abstract
Background Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. Objective The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. Methods We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. Results We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma. Conclusions While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established.
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Affiliation(s)
- Peter Hanlon
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Luke Daines
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Christine Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Brian McKinstry
- E-Health Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - David Weller
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
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23
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So CF, Chung JW. Telehealth for diabetes self-management in primary healthcare: A systematic review and meta-analysis. J Telemed Telecare 2017; 24:356-364. [PMID: 28463033 DOI: 10.1177/1357633x17700552] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Diabetes mellitus is prevalent worldwide and the majority of the patients with this metabolic disease are managed in primary healthcare settings. Self-management is, therefore, crucial for the health and wellbeing of people with diabetes. Due to the advancement of information technologies, telehealth intervention as self-management measures potentially offer a possible solution in the primary healthcare arena to cope with the increasing demand for diabetes control. Methods This study aims to systematically review the effectiveness of telehealth on diabetes control self-management in primary healthcare settings. A keyword search was conducted in six databases for randomised controlled trials. Data extraction and quality assessment of the reviewed studies were done with standardised forms and checklists. A meta-analysis was also performed in this review. Results Of the seven studies included in this review, all of them reported a decreasing level of glycated haemoglobin. Four studies examined the effect of telehealth interventions on fasting plasma glucose levels; however, the overall effects were insignificant. It is, nonetheless, encouraging to see two studies which investigated their effect on two-hour post-meal glucose levels, and showed positive effects for glycaemic control self-management in the short term. This finding, though only from two studies, points to a promising future of utilising telehealth interventions in controlling this metabolic disease in the primary healthcare arena. Conclusions This review showed positive effects of telehealth interventions for diabetes control self-management at the primary healthcare stage. Further studies are required to evaluate the cost-effectiveness of telehealth interventions.
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Affiliation(s)
- Chi F So
- 1 Post-doctoral Fellow and Adjunct Assistant Professor, The Education University of Hong Kong
| | - Joanne Wy Chung
- 2 Peter T C Lee Chair Professor of Health Studies, The Education University of Hong Kong
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24
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Faruque LI, Wiebe N, Ehteshami-Afshar A, Liu Y, Dianati-Maleki N, Hemmelgarn BR, Manns BJ, Tonelli M. Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials. CMAJ 2017; 189:E341-E364. [PMID: 27799615 PMCID: PMC5334006 DOI: 10.1503/cmaj.150885] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 07/12/2016] [Indexed: 12/24/2022] Open
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 the I2 statistic. RESULTS From 3688 citations, we identified 111 eligible RCTs (n = 23 648). Telemedicine achieved significant but modest reductions in HbA1C in 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 (I2 statistic) was 75%, 69% and 58%, respectively. In meta-regression analyses, the effect of telemedicine on HbA1C appeared greatest in trials with higher HbA1C concentrations 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. INTERPRETATION Compared with usual care, the addition of telemedicine, especially systems that allowed medication adjustments with or without text messaging or a Web portal, improved HbA1C but not other clinically relevant outcomes among patients with diabetes.
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Affiliation(s)
- Labib Imran Faruque
- 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
| | - Natasha Wiebe
- 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
| | - Arash Ehteshami-Afshar
- 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
| | - Yuanchen Liu
- 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
| | - Neda Dianati-Maleki
- 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
| | - Brenda R Hemmelgarn
- 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
| | - Braden J Manns
- 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
| | - Marcello Tonelli
- 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.
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25
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Bonoto BC, de Araújo VE, Godói IP, de Lemos LLP, Godman B, Bennie M, Diniz LM, Junior AAG. Efficacy of Mobile Apps to Support the Care of Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. JMIR Mhealth Uhealth 2017; 5:e4. [PMID: 28249834 PMCID: PMC5352856 DOI: 10.2196/mhealth.6309] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/28/2016] [Accepted: 10/23/2016] [Indexed: 01/06/2023] Open
Abstract
Background Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health apps. Objective The aim of our study was to evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist DM patients in treatment. Methods We conducted searches in the electronic databases MEDLINE (Pubmed), Cochrane Register of Controlled Trials (CENTRAL), and LILACS (Latin American and Caribbean Health Sciences Literature), including manual search in references of publications that included systematic reviews, specialized journals, and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, patients with DM, and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager software version 5.3. Results The literature search identified 1236 publications. Of these, 13 studies were included that evaluated 1263 patients. In 6 RCTs, there were a statistical significant reduction (P<.05) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (mean difference, MD −0.44; CI: −0.59 to −0.29; P<.001; I²=32%).The evaluation favored the treatment in patients who used apps without significant heterogeneity. Conclusions The use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care by contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly by reducing their fear of not knowing how to deal with potential hypoglycemic episodes that may occur.
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Affiliation(s)
- Bráulio Cezar Bonoto
- Post Graduate Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vânia Eloisa de Araújo
- Institute of Biological Sciences and Health, Faculty of Odontology, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brazil
| | - Isabella Piassi Godói
- Post Graduate Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,SUS Collaborating Centre for Technology Assessment and Excellence in Health, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Lívia Lovato Pires de Lemos
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Post Graduate Program in Public Health, Department Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Brian Godman
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, Glasgow, United Kingdom.,Division of Clinical Pharmaclogy, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marion Bennie
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, Glasgow, United Kingdom
| | - Leonardo Mauricio Diniz
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Augusto Afonso Guerra Junior
- Post Graduate Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,SUS Collaborating Centre for Technology Assessment and Excellence in Health, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
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26
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Baron JS, Hirani S, Newman SP. A randomised, controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in people with poorly controlled diabetes. J Telemed Telecare 2016; 23:207-216. [DOI: 10.1177/1357633x16631628] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective The objective of this research is to determine the effects of mobile telehealth (MTH) on glycosylated haemoglobin (HbA1c) and other clinical and patient-reported outcomes in insulin-requiring people with diabetes. Methods A nine-month randomised, controlled trial compared standard care to standard care supplemented with MTH (self-monitoring, mobile-phone data transmissions, graphical and nurse-initiated feedback, and educational calls). Clinical (HbA1c, blood pressure, daily insulin dose, diabetes outpatient appointments (DOAs)) and questionnaire data (health-related quality of life, depression, anxiety) were collected. Mean group changes over time were compared using hierarchical linear models and Mann-Whitney tests. Results Eighty-one participants with a baseline HbA1c of 8.98% ± 1.82 were randomised to the intervention ( n = 45) and standard care ( n = 36). The Group by Time effect revealed MTH did not significantly influence HbA1c ( p = 0.228), but p values were borderline significant for blood pressure ( p = 0.054) and mental-health related quality of life ( p = 0.057). Examination of effect sizes and 95% confidence intervals for mean group differences at nine months supported the existence of a protective effect of MTH on mental health-related quality of life as well as depression. None of the other measured outcomes were found to be affected by the MTH intervention. Conclusions Findings from this study must be interpreted with caution given the small sample size, but they do not support the widespread adoption of MTH to achieve clinically significant changes in HbA1c. MTH may, however, have positive effects on blood pressure and protective effects on some aspects of mental health.
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Affiliation(s)
- Justine S Baron
- Institute of Cardiovascular Science, University College London, United Kingdom (currently at the Ottawa Hospital Research Institute, Canada)
| | - Shashivadan Hirani
- Centre for Health Services Research, School of Health Sciences, City University London, United Kingdom
| | - Stanton P Newman
- Centre for Health Services Research, School of Health Sciences, City University London, United Kingdom
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27
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Tildesley HD, Chow N, White A, Pawlowska M, Ross SA. WITHDRAWN: Internet Diabetes Management: A Practical Approach. Can J Diabetes 2016; 40 Suppl 1:13-7. [PMID: 27283088 DOI: 10.1016/j.jcjd.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Hugh D Tildesley
- Division of Endocrinology, St Paul's Hospital, Vancouver, British Columbia, Canada, and Department of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Nelson Chow
- Department of Biochemistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam White
- Division of Endocrinology, St Paul's Hospital, Vancouver, British Columbia, Canada, and Department of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada
| | - Monika Pawlowska
- Department of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart A Ross
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Su D, Zhou J, Kelley MS, Michaud TL, Siahpush M, Kim J, Wilson F, Stimpson JP, Pagán JA. Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials. Diabetes Res Clin Pract 2016; 116:136-48. [PMID: 27321329 DOI: 10.1016/j.diabres.2016.04.019] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/27/2016] [Accepted: 04/16/2016] [Indexed: 12/24/2022]
Abstract
AIMS 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.
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Affiliation(s)
- Dejun Su
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Junmin Zhou
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States.
| | - Megan S Kelley
- College of Education and Human Services, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Tzeyu L Michaud
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Mohammad Siahpush
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jungyoon Kim
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Fernando Wilson
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jim P Stimpson
- School of Public Health, City University of New York, New York, NY, United States
| | - José A Pagán
- New York Academy of Medicine, New York, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Han MK, Martinez CH, Au DH, Bourbeau J, Boyd CM, Branson R, Criner GJ, Kalhan R, Kallstrom TJ, King A, Krishnan JA, Lareau SC, Lee TA, Lindell K, Mannino DM, Martinez FJ, Meldrum C, Press VG, Thomashow B, Tycon L, Sullivan JL, Walsh J, Wilson KC, Wright J, Yawn B, Zueger PM, Bhatt SP, Dransfield MT. Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective. THE LANCET RESPIRATORY MEDICINE 2016; 4:473-526. [PMID: 27185520 DOI: 10.1016/s2213-2600(16)00094-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
The burden of chronic obstructive pulmonary disease (COPD) in the USA continues to grow. Although progress has been made in the the development of diagnostics, therapeutics, and care guidelines, whether patients' quality of life is improved will ultimately depend on the actual implementation of care and an individual patient's access to that care. In this Commission, we summarise expert opinion from key stakeholders-patients, caregivers, and medical professionals, as well as representatives from health systems, insurance companies, and industry-to understand barriers to care delivery and propose potential solutions. Health care in the USA is delivered through a patchwork of provider networks, with a wide variation in access to care depending on a patient's insurance, geographical location, and socioeconomic status. Furthermore, Medicare's complicated coverage and reimbursement structure pose unique challenges for patients with chronic respiratory disease who might need access to several types of services. Throughout this Commission, recurring themes include poor guideline implementation among health-care providers and poor patient access to key treatments such as affordable maintenance drugs and pulmonary rehabilitation. Although much attention has recently been focused on the reduction of hospital readmissions for COPD exacerbations, health systems in the USA struggle to meet these goals, and methods to reduce readmissions have not been proven. There are no easy solutions, but engaging patients and innovative thinkers in the development of solutions is crucial. Financial incentives might be important in raising engagement of providers and health systems. Lowering co-pays for maintenance drugs could result in improved adherence and, ultimately, decreased overall health-care spending. Given the substantial geographical diversity, health systems will need to find their own solutions to improve care coordination and integration, until better data for interventions that are universally effective become available.
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Affiliation(s)
- MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA.
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - David H Au
- Center of Innovation for Veteran-Centered and Value-Driven Care, and VA Puget Sound Health Care System, US Department of Veteran Affairs, Seattle, WA, USA; Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Branson
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ravi Kalhan
- Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Jerry A Krishnan
- University of Illinois Hospital & Health Sciences System, University of Illinois, Chicago, IL, USA
| | - Suzanne C Lareau
- University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | | | - David M Mannino
- Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY, USA
| | - Fernando J Martinez
- Department of Internal Medicine, Weill Cornell School of Medicine, New York, NY, USA
| | - Catherine Meldrum
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - Valerie G Press
- Section of Hospital Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Byron Thomashow
- Division of Pulmonary, Critical Care and Sleep Medicine, Columbia University Medical Center, New York, NY, USA
| | - Laura Tycon
- Palliative and Supportive Institute, Pittsburgh, PA, USA
| | | | | | - Kevin C Wilson
- Boston University School of Medicine, Boston, MA, USA; American Thoracic Society, New York, NY, USA
| | - Jean Wright
- Carolinas HealthCare System, Charlotte, NC, USA
| | - Barbara Yawn
- Family and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Patrick M Zueger
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
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Polsky S, Giordano D, Voelmle MK, Garcetti R, Garg SK. Using technology to advance type 1 diabetes care among women during the reproductive years and in pregnancy. Postgrad Med 2016; 128:418-26. [PMID: 26924774 DOI: 10.1080/00325481.2016.1159910] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The prevalence of diabetes is increasing globally. Technology to improve care among individuals with diabetes is constantly being developed. Women living with Type 1 Diabetes Mellitus (T1DM) have unique challenges affecting their glucose control relating to menstrual cycles, pregnancy, and menopause. The purpose of this review is to examine the literature related to the use of technology to help women with T1DM manage their diabetes during the reproductive years, pregnancy, and beyond. Continuous subcutaneous insulin infusion (CSII) therapy can provider equivalent or better glucose control when compared with multiple daily injections (MDI), with less hypoglycemia, diabetic ketoacidosis, and weight gain. The CSII therapy has features that could help improve glucose control over the menstrual cycle, menopause, and pregnancy, although the most studied of these stages is pregnancy. Continuous glucose monitoring (CGM) can be combined with any insulin delivery system (MDI or CSII) to provide data on glucose values every few minutes and show glucose trends over time. CGM introduction can highlight glucose variability for women with T1DM, may be beneficial during pregnancy, and can reduce hypoglycemia. Sensor-augmented pump therapy and hybrid artificial pancreas (closed-loop) systems are promising tools that improve outcomes among individuals with diabetes. The use of modern technology to improve glucose and metabolic control among menopausal women with diabetes has not been well studied. Internet and phone-based technologies are emerging as important tools that may help with diabetes self-care for women living with diabetes.
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Affiliation(s)
- Sarit Polsky
- a Barbara Davis Center for Diabetes , Aurora , CO , USA
| | | | | | | | - Satish K Garg
- a Barbara Davis Center for Diabetes , Aurora , CO , USA
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Viana LV, Gomes MB, Zajdenverg L, Pavin EJ, Azevedo MJ. Interventions to improve patients' compliance with therapies aimed at lowering glycated hemoglobin (HbA1c) in type 1 diabetes: systematic review and meta-analyses of randomized controlled clinical trials of psychological, telecare, and educational interventions. Trials 2016; 17:94. [PMID: 26888087 PMCID: PMC4758163 DOI: 10.1186/s13063-016-1207-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 01/30/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Brazilian records on glycemic control in patients with type 1 diabetes show treatment efficacy. Poor patient adherence to therapeutic proposals influences these results and can be associated with social, psychological, and economic aspects, besides others factors. The aim of this study was to evaluate the efficacy of psychological, telecare, and educational interventions to improve treatment compliance among patients with type 1 diabetes. Compliance was assessed indirectly using reduction of glycated hemoglobin (HbA1c) as the principal outcome measure. METHODS Systematic review and meta-analyses of randomized controlled clinical trials (RCTs) were performed using Medline, Embase, Cochrane and Scopus databases up to April 2015. The following medical subject headings were used: Diabetes Mellitus, Type 1, Patient Compliance or Adherence, Hemoglobin A, glycated, and Randomized Controlled Trial. The principal outcome was change in HbA1c between baseline and follow-up. Where appropriate, trials were combined in meta-analysis using fixed effects models. RESULTS From 191 articles initially identified, 57 were full text reviewed, and 19 articles met the inclusion criteria providing data from 1782 patients (49.4 % males, age 18 years). The RCTs (2 to 24 months in duration) were divided into four groups according to type of intervention: psychology (seven studies; 818 patients), telecare (six studies; 494 patients); education (five studies; 349 patients), and psychoeducation (one study; 153 patients). All studies reported some type of adherence measurement of the interventions. Decrease in HbA1c was observed after psychology (MD -0.310; 95 % CI, -0.599 to -0.0210, P = 0.035) but not after telecare (MD -0.124 %; 95 % CI, -0.268, 0.020; P = 0.090) or educational (MD -0.001; 95 % CI, -0.202, 0.200; P = 0.990) interventions. CONCLUSION Psychological approaches to improve adherence to diabetes care treatment modestly reduced HbA1c in patients with type 1 diabetes; telecare and education interventions did not change glycemic control. However, the limited number of studies included as well as their methodological quality should be taken into account.
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Affiliation(s)
- Luciana Verçoza Viana
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003, Porto Alegre, RS, Brazil.
| | - Marilia Brito Gomes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Lenita Zajdenverg
- Internal Medicine Department, Diabetes Division, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Elizabeth Joao Pavin
- Department of Clinical Medicine, Universidade Estadual de Campinas, Campinas, Brazil.
| | - Mirela Jobim Azevedo
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003, Porto Alegre, RS, Brazil.
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Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [PMID: 26343551 DOI: 10.1002/14651858.cd002098.pub2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. SELECTION CRITERIA We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. MAIN RESULTS We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups. AUTHORS' CONCLUSIONS The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.
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Affiliation(s)
- Gerd Flodgren
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Headington, Oxford, Oxfordshire, UK, OX3 7LF
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Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2015; 2015:CD002098. [PMID: 26343551 PMCID: PMC6473731 DOI: 10.1002/14651858.cd002098.pub2] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. SELECTION CRITERIA We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. MAIN RESULTS We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups. AUTHORS' CONCLUSIONS The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.
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Affiliation(s)
- Gerd Flodgren
- Norwegian Institute of Public HealthThe Norwegian Knowledge Centre for the Health ServicesPilestredet Park 7OsloNorway0176
| | - Antoine Rachas
- European Hospital Georges Pompidou and Paris Descartes UniversityDepartment of IT and Public Health20‐40 Rue leBlancParisFrance75908
| | - Andrew J Farmer
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory Quarter, Walton StreetOxfordUKOX2 6GG
| | - Marco Inzitari
- Parc Sanitari Pere Virgili and Universitat Autònoma de BarcelonaDepartment of Healthcare/Medicinec Esteve Terrades 30BarcelonaSpain08023
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordOxfordshireUKOX3 7LF
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Cordova FC, Ciccolella D, Grabianowski C, Gaughan J, Brennan K, Goldstein F, Jacobs MR, Criner GJ. A Telemedicine-Based Intervention Reduces the Frequency and Severity of COPD Exacerbation Symptoms: A Randomized, Controlled Trial. Telemed J E Health 2015; 22:114-122. [PMID: 26259074 DOI: 10.1089/tmj.2015.0035] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) may not recognize worsening symptoms that require intensification of therapy. They may also be reluctant to contact a healthcare provider for minor worsening of symptoms. A telemedicine application for daily symptom reporting may reduce these barriers and improve patient outcomes. MATERIALS AND METHODS Patients hospitalized for a COPD exacerbation within the past year or using supplemental O2 were approached for participation. Patients received optimal COPD care and were given a telecommunication device for symptom reporting. Initial symptom scores were obtained while patients were in their usual state of health. Patients were randomly assigned to an intervention group or a control group (usual medical care). The control group patients were instructed to seek medical care if their condition worsened. The intervention group symptom scores were assessed by a computer algorithm and compared with initial values. Scores 1 or more points above the initial score generated an "alert," and patients were reviewed by a nurse and referred to a physician who prescribed treatment. RESULTS Eighty-six patients were screened; 79 met entry criteria and were randomized (intervention group, n=39; control group, n=40). Twelve patients submitted five or fewer symptom reports (5 intervention; 7 control) and were excluded from the analysis. Daily peak flow and dyspnea scores improved only in the intervention group. There were no differences in hospitalization and mortality rates between groups. No serious adverse events were reported. CONCLUSIONS A telemedicine-based symptom reporting program facilitated early treatment of symptoms and improved lung function and functional status.
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Affiliation(s)
- Francis C Cordova
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - David Ciccolella
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Carla Grabianowski
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - John Gaughan
- 2 Biostatistics Consulting Center, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Kathleen Brennan
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Frederick Goldstein
- 3 Department of Neuroscience, Physiology, and Pharmacology, Philadelphia College of Osteopathic Medicine , Philadelphia, Pennsylvania
| | - Michael R Jacobs
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania.,4 Temple University School of Pharmacy , Philadelphia, Pennsylvania
| | - Gerard J Criner
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania
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Karhula T, Vuorinen AL, Rääpysjärvi K, Pakanen M, Itkonen P, Tepponen M, Junno UM, Jokinen T, van Gils M, Lähteenmäki J, Kohtamäki K, Saranummi N. Telemonitoring and Mobile Phone-Based Health Coaching Among Finnish Diabetic and Heart Disease Patients: Randomized Controlled Trial. J Med Internet Res 2015; 17:e153. [PMID: 26084979 PMCID: PMC4526947 DOI: 10.2196/jmir.4059] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/30/2015] [Accepted: 04/17/2015] [Indexed: 02/04/2023] Open
Abstract
Background There is a strong will and need to find alternative models of health care delivery driven by the ever-increasing burden of chronic diseases. Objective The purpose of this 1-year trial was to study whether a structured mobile phone-based health coaching program, which was supported by a remote monitoring system, could be used to improve the health-related quality of life (HRQL) and/or the clinical measures of type 2 diabetes and heart disease patients. Methods A randomized controlled trial was conducted among type 2 diabetes patients and heart disease patients of the South Karelia Social and Health Care District. Patients were recruited by sending invitations to randomly selected patients using the electronic health records system. Health coaches called patients every 4 to 6 weeks and patients were encouraged to self-monitor their weight, blood pressure, blood glucose (diabetics), and steps (heart disease patients) once per week. The primary outcome was HRQL measured by the Short Form (36) Health Survey (SF-36) and glycosylated hemoglobin (HbA1c) among diabetic patients. The clinical measures assessed were blood pressure, weight, waist circumference, and lipid levels. Results A total of 267 heart patients and 250 diabetes patients started in the trial, of which 246 and 225 patients concluded the end-point assessments, respectively. Withdrawal from the study was associated with the patients’ unfamiliarity with mobile phones—of the 41 dropouts, 85% (11/13) of the heart disease patients and 88% (14/16) of the diabetes patients were familiar with mobile phones, whereas the corresponding percentages were 97.1% (231/238) and 98.6% (208/211), respectively, among the rest of the patients (P=.02 and P=.004). Withdrawal was also associated with heart disease patients’ comorbidities—40% (8/20) of the dropouts had at least one comorbidity, whereas the corresponding percentage was 18.9% (47/249) among the rest of the patients (P=.02). The intervention showed no statistically significant benefits over the current practice with regard to health-related quality of life—heart disease patients: beta=0.730 (P=.36) for the physical component score and beta=-0.608 (P=.62) for the mental component score; diabetes patients: beta=0.875 (P=.85) for the physical component score and beta=-0.770 (P=.52) for the mental component score. There was a significant difference in waist circumference in the type 2 diabetes group (beta=-1.711, P=.01). There were no differences in any other outcome variables. Conclusions A health coaching program supported with telemonitoring did not improve heart disease patients' or diabetes patients' quality of life or their clinical condition. There were indications that the intervention had a differential effect on heart patients and diabetes patients. Diabetes patients may be more prone to benefit from this kind of intervention. This should not be neglected when developing new ways for self-management of chronic diseases. Trial Registration ClinicalTrials.gov NCT01310491; http://clinicaltrials.gov/ct2/show/NCT01310491 (Archived by WebCite at http://www.webcitation.org/6Z8l5FwAM).
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Affiliation(s)
- Tuula Karhula
- Eksote, South Karelia Social and Health Care District, Lappeenranta, Finland
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Tildesley HD, Chow N, White A, Pawlowska M, Ross SA. Internet diabetes management: a practical approach. Can J Diabetes 2015; 39:195-9. [PMID: 25808591 DOI: 10.1016/j.jcjd.2014.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 12/07/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Hugh D Tildesley
- Division of Endocrinology, St Paul's Hospital, Vancouver, British Columbia, Canada, and Department of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Nelson Chow
- Department of Biochemistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam White
- Division of Endocrinology, St Paul's Hospital, Vancouver, British Columbia, Canada, and Department of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada
| | - Monika Pawlowska
- Department of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart A Ross
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Huang Z, Tao H, Meng Q, Jing L. Management of endocrine disease. Effects of telecare intervention on glycemic control in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Eur J Endocrinol 2015; 172:R93-101. [PMID: 25227131 DOI: 10.1530/eje-14-0441] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To review the published literature on the effects of telecare intervention in patients with type 2 diabetes and inadequate glycemic control. DESIGN AND METHODS A review of randomized controlled trials on telecare intervention in patients with type 2 diabetes, and a search of electronic databases such as The Cochrane Library, PubMed, EBSCO, CINAHL, Science Direct, Journal of Telemedicine and Telecare, and China National Knowledge Infrastructure (CNKI), were conducted from December 8 to 16, 2013. Two evaluators independently selected and reviewed the eligible studies. Changes in HbA1c, fasting plasma glucose (FPG), post-prandial plasma glucose (PPG), BMI, and body weight were analyzed. RESULTS An analysis of 18 studies with 3798 subjects revealed that telecare significantly improved the management of diabetes. Mean HbA1c values were reduced by -0.54 (95% CI, -0.75 to -0.34; P<0.05), mean FPG levels by -9.00 mg/dl (95% CI, -17.36 to -0.64; P=0.03), and mean PPG levels reduced by -52.86 mg/dl (95% CI, -77.13 to -28.58; P<0.05) when compared with the group receiving standard care. Meta-regression and subgroup analyses indicated that study location, sample size, and treatment-monitoring techniques were the sources of heterogeneity. CONCLUSIONS Patients monitored by telecare showed significant improvement in glycemic control in type 2 diabetes when compared with those monitored by routine follow-up. Significant reduction in HbA1c levels was associated with Asian populations, small sample size, and telecare, and with those patients with baseline HbA1c greater than 8.0%.
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Affiliation(s)
- Zhenru Huang
- Department of Endocrinology and MetabolismBeijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, ChinaBeijing Anzhen HospitalCapital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Hong Tao
- Department of Endocrinology and MetabolismBeijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, ChinaBeijing Anzhen HospitalCapital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Qingdong Meng
- Department of Endocrinology and MetabolismBeijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, ChinaBeijing Anzhen HospitalCapital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Long Jing
- Department of Endocrinology and MetabolismBeijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, ChinaBeijing Anzhen HospitalCapital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
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Baron J, Hirani S, Newman S. A mobile telehealth intervention for adults with insulin-requiring diabetes: early results of a mixed-methods randomized controlled trial. JMIR Res Protoc 2015; 4:e27. [PMID: 25803226 PMCID: PMC4376177 DOI: 10.2196/resprot.4035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/16/2014] [Accepted: 12/16/2014] [Indexed: 11/13/2022] Open
Abstract
Background The role of technology in health care delivery has grown rapidly in the last decade. The potential of mobile telehealth (MTH) to support patient self-management is a key area of research. Providing patients with technological tools that allow for the recording and transmission of health parameters to health care professionals (HCPs) may promote behavior changes that result in improved health outcomes. Although for some conditions the evidence of the effectiveness of MTH is clear, to date the findings on the effects of MTH on diabetes management remain inconsistent. Objective This study aims to evaluate an MTH intervention among insulin-requiring adults with diabetes to establish whether supplementing standard care with MTH results in improved health outcomes—glycated hemoglobin (HbA1c), blood pressure (BP), health-related quality of life (HRQoL), diabetes self-management behaviors, diabetes health care utilization, and diabetes self-efficacy and illness beliefs. An additional objective was to explore the acceptability of MTH and patients’ perceptions of, and experience, using it. Methods A mixed-method design consisting of a 9-month, two-arm, parallel randomized controlled trial (RCT) was used in combination with exit qualitative interviews. Quantitative data was collected at baseline, 3 months, and 9 months. Additional intervention fidelity data, such as participants’ MTH transmissions and contacts with the MTH nurse during the study, were also recorded. Results Data collection for both the quantitative and qualitative components of this study has ended and data analysis is ongoing. A total of 86 participants were enrolled into the study. Out of 86 participants, 45 (52%) were randomized to the intervention group and 36 (42%) to the control group. Preliminary data on MTH training sessions and MTH usage by intervention participants are presented in this paper. We expect to publish complete study results in 2015. Conclusions The range of data collected in this study will allow for a comprehensive evaluation of processes and outcomes. The early results presented suggest that MTH usage decreases over time and that MTH participants would benefit from attending more than one training session. Trial Registration ClinicalTrials.gov NCT00922376; http://clinicaltrials.gov/ct2/show/NCT00922376 (Archived by WebCite at http://www.webcitation.org/6Vu4nhLI6).
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Affiliation(s)
- Justine Baron
- Institute of Cardiovascular Science, University College London, London, United Kingdom
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Tildesley HD, Po MD, Ross SA. Internet blood glucose monitoring systems provide lasting glycemic benefit in type 1 and 2 diabetes: a systematic review. Med Clin North Am 2015; 99:17-33. [PMID: 25456641 DOI: 10.1016/j.mcna.2014.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Internet blood glucose monitoring systems (IBGMS) are associated with improved glycemic control in patients with type 2 diabetes (T2D) who are pharmacologically managed, using oral agents or insulin. IBGMS improves glycemic levels in patients with type 1 diabetes (T1D). IBGMS has not led to increased hypoglycemia. Mechanisms underlying IBGMS-associated glycemic improvement extend beyond optimizing insulin dose titration. The most important effects seem to be associated with increased patient self-motivation and improved patient-physician communication. IBGMS have been recommended in clinical practice guidelines, and their effectiveness and safety in trials suggest that this approach is appropriate for patients with T1D or T2D.
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Affiliation(s)
- Hugh D Tildesley
- Department of Endocrinology and Metabolism, St Paul's Hospital, University of British Columbia, Room 410, 1033 Davie Street, Vancouver, British Columbia V6E 1M7, Canada.
| | | | - Stuart A Ross
- University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
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Roca-Espino D, Orois-Añón A. El control de la diabetes a distancia. ¿Cuánto hay de verdaderamente útil bajo el término telemedicina? ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.avdiab.2014.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Esmatjes E, Jansà M, Roca D, Pérez-Ferre N, del Valle L, Martínez-Hervás S, Ruiz de Adana M, Linares F, Batanero R, Vázquez F, Gomis R, de Solà-Morales O. The efficiency of telemedicine to optimize metabolic control in patients with type 1 diabetes mellitus: Telemed study. Diabetes Technol Ther 2014; 16:435-41. [PMID: 24528195 DOI: 10.1089/dia.2013.0313] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study evaluated the impact of an Internet-based telematic system on the economic and clinical management of patients with type 1 diabetes mellitus. RESEARCH DESIGN AND METHODS This 6-month prospective, randomized, comparative, open, multicenter study included patients with type 1 diabetes >18 years old treated with multiple insulin doses and with a glycated hemoglobin (HbA1c) level of >8%. We compared an intervention group (IG) (two face-to-face and five telematic appointments) with a control group (CG) (seven face-to-face appointments). The variables studied were (1) patient and healthcare team costs, (2) metabolic control, (3) knowledge of diabetes, (4) quality of life, and (5) self-care treatment adherence. RESULTS Of the 154 patients included, 118 (76.6%) completed the study (IG, 54; CG, 64). The time used by the CG to follow the program was 823±645 min versus 353±222 min in the IG (P<0.0001). Compared with the CG, the IG required less healthcare time from the professionals (288±105 min vs. 232±89 min; P<0.001). HbA1c improved in both groups (IG, 9.2±1.5% [77.0±17.0 mmol/mol] vs. 8.7±1.5% [71.6±17.0 mmol/mol] [P<0.001]; CG, 9.2±0.9% [77.0±10.0 mmol/mol] vs. 8.6±0.9% [70.5±10.0 mmol/mol] [P<0.001], as did knowledge and self-care treatment adherence. CONCLUSIONS The use of interactive telematic appointments in subjects with type 1 diabetes and inadequate metabolic control is an efficient strategy, providing results comparable to those of face-to-face appointments in relation to improvement in glycemic control, knowledge acquisition, and self-care treatment adherence, with a significant reduction in the time used, especially by patients.
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Affiliation(s)
- Enric Esmatjes
- 1 Diabetes Unit, Hospital Clinic, University of Barcelona , Biomedical Research Center in Diabetes and Associated Metabolic Disorders, Barcelona, Spain
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Guljas R, Ahmed A, Chang K, Whitlock A. Impact of telemedicine in managing type 1 diabetes among school-age children and adolescents: an integrative review. J Pediatr Nurs 2014; 29:198-204. [PMID: 24269308 DOI: 10.1016/j.pedn.2013.10.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 10/21/2013] [Accepted: 10/25/2013] [Indexed: 02/07/2023]
Abstract
Patients with diabetes who have limited access to healthcare services are less likely to maintain adequate diabetes control. Telemedicine represents a useful solution to the strict follow up required in diabetes management. This review analyzes the impact that telemedicine has on the management of type 1 diabetes among school-age children and adolescents, as measured by compliance with blood glucose monitoring, glycemic control, satisfaction, and self management. In general, this review supports the use of telemedicine in maintaining glycemic control. Further studies are desired to observe the impact of telemedicine in managing type 1 diabetes in school-age children and adolescents.
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Affiliation(s)
| | - Azza Ahmed
- Purdue University, West Lafayette, IN, USA
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Greenwood DA, Hankins AI, Parise CA, Spier V, Olveda J, Buss KA. A Comparison of In-person, Telephone, and Secure Messaging for Type 2 Diabetes Self-Management Support. DIABETES EDUCATOR 2014; 40:516-525. [DOI: 10.1177/0145721714531337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ongoing interaction between diabetes educators and patients is necessary for making and sustaining behavior changes essential for glycemic control and subsequently reducing the complications of diabetes. Purpose The purpose of this study was to determine the feasibility of diabetes self-management support (DSMS) delivered via telephone or secure message and to compare clinical outcomes (A1C, LDL), behavioral goal achievement, and health maintenance task completion. Methods In sum, 150 persons with type 2 diabetes who completed diabetes self-management education self-selected DSMS methods: 1 in-person visit (n = 47), 3 brief visits by phone (n = 44), or 3 by secure message (n = 59) through electronic health record. DSMS included evaluation of goal achievement, barriers and facilitators, problem solving, and review of health maintenance exams. Self-reported data were collected at 9 months. Results There were no significant differences among groups in main outcomes between baseline and 9-month follow-up. Behavioral goals were achieved by 59% of in-person participants, 73% phone, and 77% secure message. Sixty-two completed the intervention per protocol: fewer online than in-person or phone groups. Mean attempts to contact participants was significantly greater in the secure message group. Phone contact was significantly longer than secure message. Conclusions Telephone and secure message was feasible for providing DSMS. Three brief contacts by phone or secure message resulted in similar outcomes when compared to an in-person visit. Secure messaging required less staff time, but increased patient engagement is needed.
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Affiliation(s)
- Deborah A. Greenwood
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
| | - Andrea I. Hankins
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
| | - Carol A. Parise
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
| | - Valerie Spier
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
| | - Joan Olveda
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
| | - Kimberly A. Buss
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
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Suh S, Jean C, Koo M, Lee SY, Cho MJ, Sim KH, Jin SM, Bae JC, Kim JH. A randomized controlled trial of an internet-based mentoring program for type 1 diabetes patients with inadequate glycemic control. Diabetes Metab J 2014; 38:134-42. [PMID: 24851207 PMCID: PMC4021300 DOI: 10.4093/dmj.2014.38.2.134] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 09/06/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To determine whether an internet-based mentoring program can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). METHODS Subjects with T1DM on intensive insulin therapy and with hemoglobin A1c (HbA1c) ≥8.0% were randomized to mentored (glucometer transmission with feedback from mentors) or control (glucometer transmission without feedback) groups and were examined for 12 weeks. Five mentors were interviewed and selected, of which two were T1DM patients themselves and three were parents with at least one child diagnosed with T1DM since more than 5 years ago. RESULTS A total of 57 T1DM adult subjects with a mean duration after being diagnosed with diabetes of 7.4 years were recruited from Samsung Medical Center. Unfortunately, the mentored group failed to show significant improvements in HbA1c levels or other outcomes, including the quality of life, after completion of the study. However, the mentored group monitored their blood glucose (1.41 vs. 0.30) and logged into our website (http://ubisens.co.kr/) more frequently (20.59 times vs. 5.07 times) than the control group. CONCLUSION A 12-week internet-based mentoring program for T1DM patients with inadequate glycemic control did not prove to be superior to the usual follow-up. However, the noted increase in the subjects' frequency of blood glucose monitoring may lead to clinical benefits.
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Affiliation(s)
- Sunghwan Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University Medical Center, Busan, Korea
| | - Cheol Jean
- Manager of JahkEunSon (Small Hands) Type 1 Diabetes Cafe, Seoul, Korea
| | - Mihyun Koo
- Department of Medical Social Work, Samsung Medical Center, Seoul, Korea
| | - Sun Young Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Ja Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kang-Hee Sim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Cheol Bae
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sinha MK, Montori VM. Reporting bias and other biases affecting systematic reviews and meta-analyses: a methodological commentary. Expert Rev Pharmacoecon Outcomes Res 2014; 6:603-11. [DOI: 10.1586/14737167.6.5.603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kirwan M, Vandelanotte C, Fenning A, Duncan MJ. Diabetes self-management smartphone application for adults with type 1 diabetes: randomized controlled trial. J Med Internet Res 2013; 15:e235. [PMID: 24225149 PMCID: PMC3841374 DOI: 10.2196/jmir.2588] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 08/22/2013] [Accepted: 09/15/2013] [Indexed: 11/29/2022] Open
Abstract
Background Persistently poor glycemic control in adult type 1 diabetes patients is a common, complex, and serious problem initiating significant damage to the cardiovascular, renal, neural, and visual systems. Currently, there is a plethora of low-cost and free diabetes self-management smartphone applications available in online stores. Objective The aim of this study was to examine the effectiveness of a freely available smartphone application combined with text-message feedback from a certified diabetes educator to improve glycemic control and other diabetes-related outcomes in adult patients with type 1 diabetes in a two-group randomized controlled trial. Methods Patients were recruited through an online type 1 diabetes support group and letters mailed to adults with type 1 diabetes throughout Australia. In a 6-month intervention, followed by a three-month follow-up, patients (n=72) were randomized to usual care (control group) or usual care and the use of a smartphone application (Glucose Buddy) with weekly text-message feedback from a Certified Diabetes Educator (intervention group). All outcome measures were collected at baseline and every three months over the study period. Patients’ glycosylated hemoglobin levels (HbA1c) were measured with a blood test and diabetes-related self-efficacy, self-care activities, and quality of life were measured with online questionnaires. Results The mean age of patients was 35.20 years (SD 10.43) (28 male, 44 female), 39% (28/72) were male, and patients had been diagnosed with type 1 diabetes for a mean of 18.94 years (SD 9.66). Of the initial 72 patients, 53 completed the study (25 intervention, 28 control group). The intervention group significantly improved glycemic control (HbA1c) from baseline (mean 9.08%, SD 1.18) to 9-month follow-up (mean 7.80%, SD 0.75), compared to the control group (baseline: mean 8.47%, SD 0.86, follow-up: mean 8.58%, SD 1.16). No significant change over time was found in either group in relation to self-efficacy, self-care activities, and quality of life. Conclusions In adjunct to usual care, the use of a diabetes-related smartphone application combined with weekly text-message support from a health care professional can significantly improve glycemic control in adults with type 1 diabetes. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12612000132842; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000132842 (Archived by WebCite at http://www.webcitation.org/6Kl4jqn5u).
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Affiliation(s)
- Morwenna Kirwan
- Institute for Health and Social Science Research, Central Queensland University, North Rockhampton, Australia.
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Marcolino MS, Maia JX, Alkmim MBM, Boersma E, Ribeiro AL. Telemedicine application in the care of diabetes patients: systematic review and meta-analysis. PLoS One 2013; 8:e79246. [PMID: 24250826 PMCID: PMC3826722 DOI: 10.1371/journal.pone.0079246] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 09/20/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The impact of telemedicine application on the management of diabetes patients is unclear, as the results are not consistent among different studies. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of telemedicine interventions on change in hemoglobin A1c (HbA1c), blood pressure, LDL cholesterol (LDL-c) and body mass index (BMI) in diabetes patients. METHODS Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched to identify relevant studies published until April 2012, supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Of the 6.258 articles retrieved, 13 RCTs (4207 patients) were included. Random effects model was applied to estimate the pooled results. RESULTS Telemedicine was associated with a statistically significant and clinically relevant absolute decline in HbA1c level compared to control (mean difference -0.44% [-4.8 mmol/mol] and 95% confidence interval [CI] -0.61 to -0.26% [-6.7 to -2.8 mmol/mol]; p<0.001). LDL-c was reduced in 6.6 mg/dL (95% CI -8.3 to -4.9; p<0.001), but the clinical relevance of this effect can be questioned. No effects of telemedicine strategies were seen on systolic (-1.6 mmHg and 95% CI -7.2 to 4.1) and diastolic blood pressure (-1.1 mmHg and 95% CI -3.0 to 0.8). The 2 studies that assessed the effect on BMI demonstrated a tendency of BMI reduction in favor of telemedicine. CONCLUSIONS Telemedicine strategies combined to the usual care were associated with improved glycemic control in diabetic patients. No clinical relevant impact was observed on LDL-c and blood pressure, and there was a tendency of BMI reduction in diabetes patients who used telemedicine, but these outcomes should be further explored in future trials.
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Affiliation(s)
- Milena Soriano Marcolino
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Junia Xavier Maia
- University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Antonio Luiz Ribeiro
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Franc S, Borot S, Ronsin O, Quesada JL, Dardari D, Fagour C, Renard E, Leguerrier AM, Vigeral C, Moreau F, Winiszewski P, Vambergue A, Mosnier-Pudar H, Kessler L, Reffet S, Guerci B, Millot L, Halimi S, Thivolet C, Benhamou PY, Penfornis A, Charpentier G, Hanaire H. Telemedicine and type 1 diabetes: is technology per se sufficient to improve glycaemic control? DIABETES & METABOLISM 2013; 40:61-66. [PMID: 24139705 DOI: 10.1016/j.diabet.2013.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 08/15/2013] [Accepted: 09/02/2013] [Indexed: 11/26/2022]
Abstract
AIM In the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA1c? METHODS Each patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as "high users" if the proportion of "informed" meals using the IDA exceeded 67% (median) and as "low users" if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA1c levels. RESULTS Among the high users, the proportion of informed meals remained stable from baseline to the end of the study 6months later (from 78.1±21.5% to 73.8±25.1%; P=0.107), but decreased in the low users (from 36.6±29.4% to 26.7±28.4%; P=0.005). As expected, HbA1c improved in high users from 8.7% [range: 8.3-9.2%] to 8.2% [range: 7.8-8.7%] in patients with (n=26) vs without (n=30) the benefit of telemonitoring/teleconsultation (-0.49±0.60% vs -0.52±0.73%, respectively; P=0.879). However, although HbA1c also improved in low users from 9.0% [8.5-10.1] to 8.5% [7.9-9.6], those receiving support via teleconsultation tended to show greater improvement than the others (-0.93±0.97 vs -0.46±1.05, respectively; P=0.084). CONCLUSION The Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations.
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Affiliation(s)
- S Franc
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France; Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France.
| | - S Borot
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, Besançon, France
| | - O Ronsin
- Department of Diabetes, Sainte-Marguerite University Hospital, Marseille, France
| | - J-L Quesada
- Department of Biostatistics, CIC-Inserm, University Hospital, Grenoble, France
| | - D Dardari
- Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France
| | - C Fagour
- Department of Endocrinology, University Hospital Pessac, Pessac, France
| | - E Renard
- Department of Endocrinology, University Hospital, Montpellier, France
| | - A-M Leguerrier
- Department of Endocrinology, University Hospital, Rennes, France
| | - C Vigeral
- Department of Diabetes, Hôtel-Dieu University Hospital, Paris, France
| | - F Moreau
- Department of Endocrinology, University Hospital, Strasbourg, France
| | - P Winiszewski
- Department of Endocrinology, Belfort Hospital, Belfort, France
| | - A Vambergue
- Clinique Marc Linquette, Department of Endocrinology and Diabetology, Lille, France
| | | | - L Kessler
- Department of Endocrinology, University Hospital, Strasbourg, France
| | - S Reffet
- Department of Endocrinology, Édouard-Herriot Hospital, Lyon, France
| | - B Guerci
- Diabetology, Nutrition, Metabolic disorders, Brabois Hospital and Center of Clinical Investigation ILCV, University Hospital, Nancy, France
| | - L Millot
- Department of Endocrinology, Bellevue Hospital, Saint-Étienne, France
| | - S Halimi
- Department of Endocrinology, Diabetology, Nutrition University Hospital, Grenoble, France; University J Fourier 1, Grenoble, France
| | - C Thivolet
- Department of Endocrinology, Édouard-Herriot Hospital, Lyon, France
| | - P-Y Benhamou
- Department of Endocrinology, Diabetology, Nutrition University Hospital, Grenoble, France
| | - A Penfornis
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, Besançon, France
| | - G Charpentier
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France; Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France
| | - H Hanaire
- Department of Diabetes, Rangueil University Hospital, Toulouse, France
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McLean S, Sheikh A, Cresswell K, Nurmatov U, Mukherjee M, Hemmi A, Pagliari C. The impact of telehealthcare on the quality and safety of care: a systematic overview. PLoS One 2013; 8:e71238. [PMID: 23977001 PMCID: PMC3747134 DOI: 10.1371/journal.pone.0071238] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/27/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Telehealthcare involves the use of information and communication technologies to deliver healthcare at a distance and to support patient self-management through remote monitoring and personalised feedback. It is timely to scrutinise the evidence regarding the benefits, risks and costs of telehealthcare. METHODS AND FINDINGS Two reviewers searched for relevant systematic reviews published from January 1997 to November 2011 in: The Cochrane Library, MEDLINE, EMBASE, LILACS, IndMed and PakMed. Reviewers undertook independent quality assessment of studies using the Critical Appraisal Skills Programme (CASP) tool for systematic reviews. 1,782 review articles were identified, from which 80 systematic reviews were selected for inclusion. These covered a range of telehealthcare models involving both synchronous (live) and asynchronous (store-and-forward) interactions between provider and patients. Many studies showed no differences in outcomes between telehealthcare and usual care. Several reviews highlighted the large number of short-term (<12 months) feasibility studies with under 20 participants. Effects of telehealthcare on health service indicators were reported in several reviews, particularly reduced hospitalisations. The reported clinical effectiveness of telehealthcare interventions for patients with long-term conditions appeared to be greatest in those with more severe disease at high-risk of hospitalisation and death. The failure of many studies to adequately describe the intervention makes it difficult to disentangle the contributions of technological and human/organisational factors on the outcomes reported. Evidence on the cost-effectiveness of telehealthcare remains sparse. Patient safety considerations were absent from the evaluative telehealthcare literature. CONCLUSIONS Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.
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Affiliation(s)
- Susannah McLean
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Aziz Sheikh
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Kathrin Cresswell
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ulugbek Nurmatov
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Mome Mukherjee
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Akiko Hemmi
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Claudia Pagliari
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
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50
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Kitsiou S, Paré G, Jaana M. Systematic reviews and meta-analyses of home telemonitoring interventions for patients with chronic diseases: a critical assessment of their methodological quality. J Med Internet Res 2013; 15:e150. [PMID: 23880072 PMCID: PMC3785977 DOI: 10.2196/jmir.2770] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/10/2013] [Accepted: 07/10/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Systematic reviews and meta-analyses of home telemonitoring interventions for patients with chronic diseases have increased over the past decade and become increasingly important to a wide range of clinicians, policy makers, and other health care stakeholders. While a few criticisms about their methodological rigor and synthesis approaches have recently appeared, no formal appraisal of their quality has been conducted yet. OBJECTIVE The primary aim of this critical review was to evaluate the methodology, quality, and reporting characteristics of prior reviews that have investigated the effects of home telemonitoring interventions in the context of chronic diseases. METHODS Ovid MEDLINE, the Database of Abstract of Reviews of Effects (DARE), and Health Technology Assessment Database (HTA) of the Cochrane Library were electronically searched to find relevant systematic reviews, published between January 1966 and December 2012. Potential reviews were screened and assessed for inclusion independently by three reviewers. Data pertaining to the methods used were extracted from each included review and examined for accuracy by two reviewers. A validated quality assessment instrument, R-AMSTAR, was used as a framework to guide the assessment process. RESULTS Twenty-four reviews, nine of which were meta-analyses, were identified from more than 200 citations. The bibliographic search revealed that the number of published reviews has increased substantially over the years in this area and although most reviews focus on studying the effects of home telemonitoring on patients with congestive heart failure, researcher interest has extended to other chronic diseases as well, such as diabetes, hypertension, chronic obstructive pulmonary disease, and asthma. Nevertheless, an important number of these reviews appear to lack optimal scientific rigor due to intrinsic methodological issues. Also, the overall quality of reviews does not appear to have improved over time. While several criteria were met satisfactorily by either all or nearly all reviews, such as the establishment of an a priori design with inclusion and exclusion criteria, use of electronic searches on multiple databases, and reporting of studies characteristics, there were other important areas that needed improvement. Duplicate data extraction, manual searches of highly relevant journals, inclusion of gray and non-English literature, assessment of the methodological quality of included studies and quality of evidence were key methodological procedures that were performed infrequently. Furthermore, certain methodological limitations identified in the synthesis of study results have affected the results and conclusions of some reviews. CONCLUSIONS Despite the availability of methodological guidelines that can be utilized to guide the proper conduct of systematic reviews and meta-analyses and eliminate potential risks of bias, this knowledge has not yet been fully integrated in the area of home telemonitoring. Further efforts should be made to improve the design, conduct, reporting, and publication of systematic reviews and meta-analyses in this area.
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Affiliation(s)
- Spyros Kitsiou
- Canada Research Chair in Information Technology in Health Care, HEC Montreal, Montreal, QC, Canada.
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