Effectiveness of Telemedicine in Managing Diabetes in Pregnancy: A Systematic Review and Meta-Analysis.
gestational diabetes mellitus
glycemic control
pregnancy
self-monitoring
systematic review
telehealth
Journal
Journal of diabetes science and technology
ISSN: 1932-2968
Titre abrégé: J Diabetes Sci Technol
Pays: United States
ID NLM: 101306166
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
medline:
9
10
2023
pubmed:
10
5
2022
entrez:
9
5
2022
Statut:
ppublish
Résumé
Strict monitoring of blood glucose during pregnancy is essential for ensuring optimal maternal and neonatal outcomes. Telemedicine could be a promising solution for supporting diabetes management; however, an updated meta-analysis is warranted. This study assesses the effects of telemedicine solutions for managing gestational and pregestational diabetes. PubMed, EMBASE, Cochrane Library Central Register of Controlled Trials, and CINAHL were searched up to October 14, 2020. All randomized trials assessing the effects of telemedicine in managing diabetes in pregnancy relative to any comparator without the use of telemedicine were included. The primary outcome was infant birth weight. A meta-analysis comparing the mean difference (MD) in birth weight across studies was applied, and subgroup and sensitivity analyses were performed. The revised Cochrane tool was applied to assess the risk of bias, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. From a total of 18 studies, ten (totaling 899 participants) were used to calculate the effect on infant birth weight. The results nonsignificantly favored the control (MD of 19.34 g; [95% confidence interval, CI -47.8; 86.47]), with moderate effect certainty. Heterogeneity was moderate ( No evidence was found to support telemedicine as an alternative to usual care when considering maternal and fetal outcomes. However, further research is needed, including economic evaluations.
Sections du résumé
BACKGROUND
Strict monitoring of blood glucose during pregnancy is essential for ensuring optimal maternal and neonatal outcomes. Telemedicine could be a promising solution for supporting diabetes management; however, an updated meta-analysis is warranted. This study assesses the effects of telemedicine solutions for managing gestational and pregestational diabetes.
METHODS
PubMed, EMBASE, Cochrane Library Central Register of Controlled Trials, and CINAHL were searched up to October 14, 2020. All randomized trials assessing the effects of telemedicine in managing diabetes in pregnancy relative to any comparator without the use of telemedicine were included. The primary outcome was infant birth weight. A meta-analysis comparing the mean difference (MD) in birth weight across studies was applied, and subgroup and sensitivity analyses were performed. The revised Cochrane tool was applied to assess the risk of bias, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
RESULTS
From a total of 18 studies, ten (totaling 899 participants) were used to calculate the effect on infant birth weight. The results nonsignificantly favored the control (MD of 19.34 g; [95% confidence interval, CI -47.8; 86.47]), with moderate effect certainty. Heterogeneity was moderate (
CONCLUSIONS
No evidence was found to support telemedicine as an alternative to usual care when considering maternal and fetal outcomes. However, further research is needed, including economic evaluations.
Identifiants
pubmed: 35533131
doi: 10.1177/19322968221094626
pmc: PMC10563542
doi:
Substances chimiques
Blood Glucose
0
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1364-1375Déclaration de conflit d'intérêts
Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Références
Int J Gynaecol Obstet. 1999 Feb;64(2):141-6
pubmed: 10189022
JMIR Res Protoc. 2020 Nov 3;9(11):e22062
pubmed: 33141100
BMC Med Res Methodol. 2005 Apr 20;5:13
pubmed: 15840177
Int J Gynaecol Obstet. 2004 Feb;84(2):114-9
pubmed: 14871512
Curr Diab Rep. 2012 Feb;12(1):33-42
pubmed: 22139557
J Telemed Telecare. 2018 Jun;24(5):356-364
pubmed: 28463033
Indian J Endocrinol Metab. 2016 Jul-Aug;20(4):481-90
pubmed: 27366714
Diabetes Technol Ther. 2019 Sep;21(9):514-521
pubmed: 31287736
Diabetes Res Clin Pract. 2015 Oct;110(1):1-9
pubmed: 26264410
BMC Health Serv Res. 2017 Dec 15;17(1):824
pubmed: 29246221
JAMA Pediatr. 2019 Apr 1;173(4):371-378
pubmed: 30801637
JMIR Mhealth Uhealth. 2018 Mar 20;6(3):e71
pubmed: 29559428
Diabetes Care. 2018 Jan;41(Suppl 1):S137-S143
pubmed: 29222384
Int J Nurs Stud. 2021 May;117:103883
pubmed: 33548591
J Clin Epidemiol. 2013 Feb;66(2):151-7
pubmed: 22542023
Ecancermedicalscience. 2018 Jul 11;12:853
pubmed: 30079115
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
BMC Pregnancy Childbirth. 2018 Apr 11;18(1):91
pubmed: 29642898
BMJ Open. 2019 Nov 11;9(11):e030884
pubmed: 31719080
Diabetes Technol Ther. 2017 Feb;19(S1):S59-S73
pubmed: 28192015
BMJ. 2006 Jul 22;333(7560):177
pubmed: 16782722
Am J Obstet Gynecol. 2018 Apr;218(4):453.e1-453.e7
pubmed: 29425836
Obstet Gynecol. 2014 Apr;123(4):737-44
pubmed: 24785599
Telemed J E Health. 2019 Jul;25(7):569-583
pubmed: 30124394
Diabetes Metab Res Rev. 2018 Jan;34(1):
pubmed: 28843034
Diabetes Res Clin Pract. 2018 Nov;145:15-16
pubmed: 29702140
Saudi Med J. 2000 Apr;21(4):335-9
pubmed: 11533813
Diabetes Technol Ther. 2015 Dec;17(12):880-8
pubmed: 26394017
BMC Med Res Methodol. 2014 Dec 19;14:135
pubmed: 25524443
J Clin Epidemiol. 2011 Dec;64(12):1294-302
pubmed: 21803546
Int J Endocrinol. 2010;2010:386941
pubmed: 20628517
Diabetes Res Clin Pract. 2018 Aug;142:276-285
pubmed: 29885390
Nutrients. 2019 Mar 11;11(3):
pubmed: 30862052
BMC Pregnancy Childbirth. 2019 Jun 13;19(1):200
pubmed: 31196116
J Med Internet Res. 2017 May 17;19(5):e172
pubmed: 28526671
Psychol Sport Exerc. 2017 May;30:73-81
pubmed: 28428728
Curr Diab Rep. 2016 Jan;16(1):7
pubmed: 26742932
Diabetes Res Clin Pract. 2018 Apr;138:271-281
pubmed: 29496507
J Clin Epidemiol. 2013 Feb;66(2):173-83
pubmed: 23116689
Nat Rev Endocrinol. 2019 Jul;15(7):406-416
pubmed: 30948803
Ann Ist Super Sanita. 1997;33(3):347-51
pubmed: 9542261
Diabetes Ther. 2021 Mar;12(3):629-639
pubmed: 33474646
J Diabetes Res. 2017;2017:3578075
pubmed: 28828389
J Clin Epidemiol. 2011 Dec;64(12):1283-93
pubmed: 21839614
Ultrasound Obstet Gynecol. 2019 Sep;54(3):319-325
pubmed: 30938000
Cleve Clin J Med. 2018 Dec;85(12):938-942
pubmed: 30526749
Clin Ther. 2019 Nov;41(11):2426-2434
pubmed: 31587813
BMJ. 2019 Aug 28;366:l4898
pubmed: 31462531
Diabetes Technol Ther. 2012 Jul;14(7):624-9
pubmed: 22512287
Diabet Med. 1996 Feb;13(2):189-91
pubmed: 8641127
Am J Perinatol. 2016 Oct;33(12):1145-51
pubmed: 27398697
Diabetes Metab Syndr. 2019 Mar - Apr;13(2):1353-1357
pubmed: 31336491
J Med Internet Res. 2016 Nov 09;18(11):e290
pubmed: 27829574
J Pharm Policy Pract. 2018 Feb 1;11:3
pubmed: 29435335
J Int Med Res. 2019 Feb;47(2):754-764
pubmed: 30442052
Diabetes Care. 2021 Jan;44(Suppl 1):S200-S210
pubmed: 33298425
J Endocrinol Invest. 2019 Jun;42(6):709-714
pubmed: 30406378
J Clin Epidemiol. 2011 Dec;64(12):1277-82
pubmed: 21802904
J Res Med Sci. 2021 Feb 16;26:11
pubmed: 34084190
J Diabetes Sci Technol. 2013 May 01;7(3):587-95
pubmed: 23759390
Diabetes Care. 2019 Jan;42(Suppl 1):S165-S172
pubmed: 30559240
CMAJ. 2017 Mar 6;189(9):E341-E364
pubmed: 27799615
Midwifery. 2019 Jan;68:39-47
pubmed: 30343264
J Diabetes Complications. 2018 Jul;32(7):635-642
pubmed: 29907325
BMC Pregnancy Childbirth. 2020 Apr 6;20(1):198
pubmed: 32252676
Diabetes Technol Ther. 2007 Jun;9(3):297-306
pubmed: 17561800
J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):301-14
pubmed: 18507601
JAMA. 2019 May 14;321(18):1811-1819
pubmed: 31087027
J Clin Epidemiol. 2011 Dec;64(12):1303-10
pubmed: 21802903
J Clin Epidemiol. 2011 Apr;64(4):407-15
pubmed: 21247734
J Telemed Telecare. 2007;13(1):44-7
pubmed: 17288659