OBJECTIVE: This study aims to systematically review the evidence on the effectiveness of telemedicine interventions compared with usual care on glycemic control among children and adolescents with T1DM.
METHODS: In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Embase, Web of Science (all databases), and CINAHL Complete from database inception to May 2023. We included randomized controlled trials (RCTs) that evaluated the effectiveness of a telemedicine intervention on glycemic control in children and adolescents with T1DM. In total, 2 independent reviewers performed the study selection and data extraction. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Our primary outcome was glycated hemoglobin (HbA1c) levels. Secondary outcomes were quality of life, self-monitoring of blood glucose, the incidence of hypoglycemia, and cost-effectiveness. A random-effects model was used for this meta-analysis.
RESULTS: Overall, 20 RCTs (1704 participants from 12 countries) were included in the meta-analysis. Only 5% (1/20) of the studies were at high risk of bias. Compared to usual care, telemedicine was found to reduce HbA1c levels by 0.22 (95% CI -0.33 to -0.10; P<.001; I2=35%). There was an improvement in self-monitoring of blood glucose (mean difference [MD] 0.54, 95% CI -0.72 to 1.80; P=.40; I2=67.8%) and the incidence of hypoglycemia (MD -0.15, 95% CI -0.57 to 0.27; P=.49; I2=70.7%), although this was not statistically significant. Moreover, telemedicine had no convincing effect on the Diabetes Quality of Life for Youth score (impact of diabetes: P=.59; worries about diabetes: P=.71; satisfaction with diabetes: P=.68), but there was a statistically significant improvement in non-youth-specific quality of life (MD -0.24, 95% CI -0.45 to -0.02; P=.04; I2=0%). Subgroup analyses revealed that the effect of telemedicine on HbA1c levels appeared to be greater in studies involving children (MD -0.41, 95% CI -0.62 to -0.20; P<.001), studies that lasted <6 months (MD -0.32, 95% CI -0.48 to -0.17; P<.001), studies where providers used smartphone apps to communicate with patients (MD -0.37, 95% CI -0.53 to -0.21; P<.001), and studies with medication dose adjustment (MD -0.25, 95% CI -0.37 to -0.12; P<.001).
CONCLUSIONS: Telemedicine can reduce HbA1c levels and improve quality of life in children and adolescents with T1DM. Telemedicine should be regarded as a useful supplement to usual care to control HbA1c levels and a potentially cost-effective mode. Meanwhile, researchers should develop higher-quality RCTs using large samples that focus on hard clinical outcomes, cost-effectiveness, and quality of life.
目的:本研究旨在系统评价在儿童和青少年T1DM患者中,远程医疗干预与常规护理对血糖控制的有效性的证据。
方法:在本系统综述和荟萃分析中,我们搜索了PubMed,科克伦图书馆,Embase,WebofScience(所有数据库),从数据库开始到2023年5月,andCINAHL完成。我们纳入了随机对照试验(RCT),评估了远程医疗干预对儿童和青少年T1DM血糖控制的有效性。总的来说,2名独立评审员进行了研究选择和数据提取。使用Cochrane偏差风险2工具评估研究质量。我们的主要结果是糖化血红蛋白(HbA1c)水平。次要结果是生活质量,自我监测血糖,低血糖的发生率,和成本效益。该荟萃分析使用随机效应模型。
结果:总体而言,20项RCT(来自12个国家的1704名参与者)纳入荟萃分析。只有5%(1/20)的研究存在高偏倚风险。与常规护理相比,发现远程医疗可使HbA1c水平降低0.22(95%CI-0.33至-0.10;P<.001;I2=35%)。血糖的自我监测有所改善(平均差异[MD]0.54,95%CI-0.72至1.80;P=.40;I2=67.8%)和低血糖的发生率(MD-0.15,95%CI-0.57至0.27;P=.49;I2=70.7%),尽管这在统计学上并不显着。此外,远程医疗对青少年糖尿病生活质量评分没有令人信服的影响(糖尿病的影响:P=.59;对糖尿病的担忧:P=.71;对糖尿病的满意度:P=.68),但在非青年特定生活质量方面有统计学显著改善(MD-0.24,95%CI-0.45至-0.02;P=.04;I2=0%).亚组分析显示,在涉及儿童的研究中,远程医疗对HbA1c水平的影响似乎更大(MD-0.41,95%CI-0.62至-0.20;P<.001),持续<6个月的研究(MD-0.32,95%CI-0.48至-0.17;P<.001),提供者使用智能手机应用程序与患者沟通的研究(MD-0.37,95%CI-0.53至-0.21;P<.001),和药物剂量调整的研究(MD-0.25,95%CI-0.37至-0.12;P<.001)。
结论:远程医疗可降低儿童和青少年T1DM患者的HbA1c水平并改善其生活质量。远程医疗应被视为控制HbA1c水平的常规护理的有用补充和潜在的成本效益模式。同时,研究人员应该使用大样本开发更高质量的RCT,专注于艰难的临床结果,成本效益,和生活质量。