Abstract
Introduction: Diabetes is an increasingly prevalent and costly chronic disease worldwide and a large cause of unnecessary disease burden. As a growing health issue, diabetes needs a focus on better management by community providers, rather than relying on an overstretched hospital-based specialist service. Conventional outpatient care is increasingly insufficient to manage diabetes. The rapid uptake of telehealth and other forms of virtual care during the COVID-19 pandemic presents a new opportunity to provide diabetes care remotely, potentially increasing the accessibility and efficiency of outpatient services. This review is to identify what evidence exists relating to the various virtual care models including telemedicine or telehealth.
Methods: We conducted systematic searches of the databases PubMED, Embase, Medline, Scopus, CINAHL and Cochrane CENTRAL, to identify relevant studies published from January 2011 to January 2022 for telemedicine, telehealth, or virtual interventions for diabetes management. The primary outcome was HbA1c, and secondary outcomes were blood glucose control, medication adherence, self-management behaviour. The protocol was registered with PROSPERO (CRD42022366125).
Results: From 10708 articles, 62 underwent full text review (2 reviews of reviews, 30 systematic reviews, 24 quantitative, and 5 qualitative studies), with data extracted from 30 Systematic reviews. 25 of the reviews reported that virtual care improved HbA1c compared to usual care. Significant changes were reported mainly for samples of patients with HbA1c >7% at baseline and for short-term interventions (≤3 months). There were a number of forms of virtual care, including videoconferencing, telephone calls, text messaging, glucometers and web-based solutions.
Discussion: Substantial research evidence supports the use of telehealth to improve outpatient care for people with diabetes. This evidence mostly reflects the impact on HbA1c, with fewer studies reporting on other health outcomes. Virtual care could facilitate integration between healthcare systems and to strengthen the capacity and capabilities of healthcare providers.