Abstract
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disorder that poses substantial challenges to global health care systems and patient management. Telemedicine, defined as the use of information and communication technologies to enhance health care delivery, has emerged as a potential tool to improve access to care and facilitate the management of T2DM. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the clinical effectiveness of various telemedicine interventions compared with usual care in glycemic control, and cardiovascular health in adults with T2DM. METHODS: A comprehensive literature search was conducted across databases such as PubMed, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) published up to August 23, 2024. Eligible RCTs compared telemedicine interventions with usual care in adults with T2DM. The primary outcome assessed was hemoglobin A(1c) (HbA(1c)) levels, while the secondary outcomes included mean glucose, fasting blood glucose, BMI, weight, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. The quality of the included studies was examined via the Cochrane risk-of-bias tool. Data were extracted and analyzed using a random-effects model, and meta-regression was performed to explore potential moderators. The quality of the evidence was assessed via the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: A total of 58 RCTs, encompassing 13,942 participants, were included in the analysis. Our findings showed that telemedicine interventions significantly improved HbA(1c) levels compared with usual care (mean difference [MD] -0.38, 95% CI -0.49 to -0.27; Z=6.94; P<.001), despite high heterogeneity (I²=96%). Significant effects were also found for fasting blood glucose (MD -11.29, 95% CI -17.65 to -4.93; Z=3.48; P<.001), weight (MD -1.33, 95% CI -2.23 to -0.44; Z=2.91; P=.004), BMI (MD -0.43, 95% CI -0.72 to -0.13; Z=2.84; P=.004), systolic blood pressure (MD -2.14, 95% CI -3.02 to -1.26; Z=4.76; P<.001), and diastolic blood pressure (MD -1.24, 95% CI -2.02 to -0.46; Z=1.10; P=.002). No significant between-group differences were found in high-density lipoprotein cholesterol and low-density lipoprotein cholesterol improvement. Subgroup analyses revealed that telemedicine delivered by physicians, dietitians, and researchers achieved the most significant reductions in HbA(1c) levels. Short-term and long-term interventions showed significant HbA(1c) improvements, while medium-term interventions did not achieve statistical significance. Meta-regression analysis did not identify any statistically significant moderators. CONCLUSIONS: This review highlights telemedicine's superior effectiveness over usual care in improving HbA(1c) levels in patients with T2DM, regardless of the type of intervention. Telemedicine led by physicians, dietitians, and researchers showed the greatest efficacy in managing blood glucose levels. Furthermore, telemedicine interventions show promise for monitoring weight and cardiovascular health in patients with T2DM. TRIAL REGISTRATION: PROSPERO CRD42024608130; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=608130.