COVID-19大流行期间远程医疗对2型糖尿病患者血糖控制的有效性:随机对照试验的系统回顾和荟萃分析

IF 3.1 Q1 NURSING International Journal of Nursing Studies Advances Pub Date : 2023-12-01 DOI:10.1016/j.ijnsa.2023.100169

Chantira Chiaranai , Saranya Chularee , Surasak Saokaew , Patraporn Bhatarasakoon , Adinat Umnuaypornlert , Natthaya Chaomuang , Nudchaporn Doommai , Porntip Nimkuntod

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引用次数: 0

摘要

在2019冠状病毒病大流行期间，远程医疗被用于改善2型糖尿病患者的临床结果。然而，远程保健的有效性仍然没有定论。目的探讨大流行期间远程医疗对2型糖尿病患者血糖控制的影响。设计随机对照试验的系统评价和荟萃分析。总共669项研究来自电子数据库，包括EMBASE、PubMed和Scopus。其中纳入12项随机对照试验，1498名受试者。方法在电子数据库中进行全面检索。采用Cochrane偏倚风险工具评估纳入研究的质量，采用I²和科克伦Q检验评估统计异质性。随机效应模型用于合并结果。建议、评估、发展和评价的分级用于评估证据的确定性。结果荟萃分析显示，与接受常规护理的参与者相比，接受远程医疗干预的参与者糖化血红蛋白(HbA1C)的降低幅度更大，加权平均差异为-0.59 (95% CI -0.84至-0.35,p <.001, I²= 74.1%，证据确定性高)。此外，接受远程医疗干预的参与者经历了更好的次要结果，包括空腹血糖降低(16.06%，95% CI -29.64至-2.48,p = 0.02，证据的高确定性)，体重指数降低(1.5%，95% CI -1.98至-1.02,p <.001，证据高确定性)，以及低密度脂蛋白的减少(7.8%，95% CI -14.69至-0.88,p = 0.027，证据低确定性)。结论在我们的综述中，我们发现远程医疗对2型糖尿病患者血糖控制的积极影响。医疗保健专业人员可以在糖尿病护理中使用远程医疗。由于结果的异质性，需要谨慎。进一步的研究应探讨远程医疗干预的长期影响。注册:本研究注册号为PROSPERO, CRD42022381879。

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Effectiveness of telehealth on the glycemic control of patients with type 2 diabetes mellitus during the COVID-19 pandemic: A systematic review and meta-analysis of randomised controlled trials

Background

During the COVID-19 pandemic, telehealth was employed to enhance clinical outcomes for patients with type 2 diabetes mellitus. However, the effectiveness of telehealth remains inconclusive.

Objective

This study aimed to examine the impact of telehealth on the glycemic control of individuals with type 2 diabetes mellitus during the pandemic.

Design

A systematic review and meta-analysis of randomized controlled trials.

Setting

N/A

Participants

A total of 669 studies was sourced from electronic databases, including EMBASE, PubMed, and Scopus. Among these, twelve randomized controlled trials, comprising 1498 participants, were included.

Methods

A comprehensive search was performed in electronic databases. The quality of the included studies was assessed using the Cochrane Risk of Bias tool, and statistical heterogeneity was assessed using I² and Cochran's Q tests. A random-effects model was utilized to combine the outcomes. Grading of Recommendations, Assessment, Development, and Evaluations was used to evaluate the certainty of the evidence.

Results

The meta-analysis showed that participants receiving a telehealth intervention achieved a greater reduction in the glycated haemoglobin (HbA1C) compared to those receiving usual care, with a weighted-mean difference of -0.59 (95 % CI -0.84 to -0.35, p < .001, I² = 74.1 %, high certainty of evidence). Additionally, participants receiving telehealth interventions experienced better secondary outcomes, including a reduction in fasting blood sugar (16.06 %, 95 %CI -29.64 to -2.48, p = .02, high certainty of evidence), a decrease in body mass index (1.5 %, 95 %CI -1.98 to -1.02, p < .001, high certainty of evidence), and a decrease in low-density lipoprotein (7.8 %, 95 %CI -14.69 to -0.88, p = .027, low certainty of evidence).

Conclusions

In our review, we showed telehealth's positive impact on glycaemic control in type 2 diabetes mellitus patients. Healthcare professionals can use telehealth in diabetes care. Caution is needed due to heterogeneity of the results. Further research should explore the long-term impacts of telehealth interventions.