Distal technology interventions in people with diabetes: an umbrella review of multiple health outcomes
P. Chakranon
Faculty of Pharmacy, Silapakorn University, Pathom, Thailand
Search for more papers by this authorY. K. Lai
Department of Pharmacy, Hospital Universiti Kebangsaan Malaysia, Cheras, Malaysia
Search for more papers by this authorY. W. Tang
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
Search for more papers by this authorP. Choudhary
Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
Search for more papers by this authorK. Khunti
Diabetes Research Centre, University of Leicester, Leicester, UK
Search for more papers by this authorCorresponding Author
S. W. H. Lee
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Selangor, Malaysia
School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylors, Selangor, Malaysia
Correspondence to: Shaun Wen Huey Lee. E-mail: [email protected]Search for more papers by this authorP. Chakranon
Faculty of Pharmacy, Silapakorn University, Pathom, Thailand
Search for more papers by this authorY. K. Lai
Department of Pharmacy, Hospital Universiti Kebangsaan Malaysia, Cheras, Malaysia
Search for more papers by this authorY. W. Tang
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
Search for more papers by this authorP. Choudhary
Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
Search for more papers by this authorK. Khunti
Diabetes Research Centre, University of Leicester, Leicester, UK
Search for more papers by this authorCorresponding Author
S. W. H. Lee
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Selangor, Malaysia
School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylors, Selangor, Malaysia
Correspondence to: Shaun Wen Huey Lee. E-mail: [email protected]Search for more papers by this authorAbstract
Aim
To summarize and evaluate the existing evidence on the effectiveness of distal technology with regard to multiple health outcomes in people with diabetes.
Methods
We searched PubMed, EMBASE and the Cochrane Database of Systematic Reviews from database inception to 31 August 2018 for systematic reviews and/or meta-analyses of studies that examined the impact of distal technology and reported any clinical or patient-related outcomes among people with type 1 or type 2 diabetes.
Results
The umbrella review identified 95 reviews, including 162 meta-analyses with 46 unique outcomes. Evidence from meta-analyses of randomized controlled studies supports the use of distal technology, especially telehealth and mHealth (healthcare delivered by mobile technology), in people with diabetes for improving HbA1c values by 2–4 mmol/mol (0.2–0.4%). For other health outcomes, such as changes in fasting plasma glucose levels, risk of diabetic ketoacidosis or frequency of severe hypoglycaemia, the evidence was weaker. No evidence was reported for most patient-reported outcomes including quality of life, self-efficacy and medication-taking. The evidence base was poor, with most studies rated as low to very low quality.
Conclusion
Distal technologies were associated with a modest improvement in glycaemic control, but it was unclear if they improved major clinical outcomes or were cost-effective in people with diabetes. More robust research to improve wider outcomes in people with diabetes is needed before such technologies can be recommended as part of routine care for any patient group.
Open Research
Data availability statement
All data generated and analysed in this study are available from the corresponding author on reasonable request.
Supporting Information
| Filename | Description |
|---|---|
| dme14156-sup-0001-Appendix.docxWord document, 132 KB |
Appendix S1. Search strategies. Appendix S2. Inclusion criteria for the current study. Appendix S3. Grading of evidence from reported summary estimates of effects. Appendix S4. List of articles included in the review. Table S1. Detailed characteristics of studies that are included in the current review. Table S2. Characteristics and quantitative synthesis of meta-analyses for diabetes using distal technology. All data presented have been recalculated. Table S3. Evaluation of small study effects and excess significance bias. Table S4. AMSTAR2 ratings for studies included in the current review. Table S5. Details of GRADE classification. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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