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Home / Publications / Telemedicine to deliver diabetes care in low-and middle-income countries: A systematic review and meta-analysis

Telemedicine to deliver diabetes care in low-and middle-income countries: A systematic review and meta-analysis

  • Authors: Jorge César Correia, Hafsa Meraj, Soo Huat Teoh, Ahmed Waqas, Maaz Ahmad, Luís Velez Lapão, Zoltan Patakya, Alain Golay
  • Publication Year: 2021
  • Journal: Bulletin of the World Health Organization, 99(3), pp 209–219B
  • Link: https://doi.org/10.2471/BLT.19.250068

ABSTRACT

‘Objective:’

To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries.

‘Methods:’

We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties.

‘Findings:’

We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of −0.38 for glycated haemoglobin (95% confidence interval, CI: −0.52 to −0.23; I2 = 86.70%), −0.20 for fasting blood sugar (95% CI: −0.32 to −0.08; I2 = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I2 = 93.75%), 0.55 for diabetes knowledge (95% CI: −0.10 to 1.20; I2 = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I2 = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of −0.04 for body mass index (95% CI: −0.13 to 0.05; I2 = 35.94%), −0.06 for total cholesterol (95% CI: −0.16 to 0.04; I2 = 59.93%) and −0.02 for triglycerides (95% CI: −0.12 to 0.09; I2 = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications.

‘Conclusion:’

Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.

KEYWORDS

telemedicine; diabetes; care; low-income countries; middle-income countries.

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About GHTM

GHTM is a R&D Unit that brings together researchers with a track record in Tropical Medicine and International & Global Health. It aims at strengthening Portugal's role as a leading partner in the development and implementation of a global health research agenda. Our evidence-based interventions contribute to the promotion of equity in health and to improve the health of populations.

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