Telemedicine for Diabetes Mellitus Management in Older Adults: A Systematic Review

Article ID: e190522205042 Pages: 7

  • * (Excluding Mailing and Handling)

Abstract

Background: Diabetes mellitus affects almost 20% of the world’s population between 65 and 99 years old. The care for this disease urges a complex, multidisciplinary, and stepwise approach. Telemedicine has been evaluated, and clinical trials as well as systematic reviews have been performed, and most have shown the benefits of its use in DM management. However, as the prevalence of diabetes mellitus increases, as well as the population ages, considerations regarding access and compliance of older patients to such technologies arise.

Objective: The study aimed to determine the efficacy of telemedicine medical consultations in comparison to standard face-to-face consultations.

Methods: A systematic literature search to identify trials investigating the effect of telemedicine medical consultations in clinical-laboratory aspects of DM management was conducted. The search was carried out in electronic databases: Medline, EMBASE, LILACS, ClinicalTrials.gov, and the CENTRAL Cochrane. Two authors independently assessed the included studies using the proper bias assessment tool for each study design.

Results: In agreement with the eligibility criteria, three studies were included. In terms of the main outcome, HbA1c, only one out of three articles showed a significant difference between the groups, favoring patients in the telemedicine group. With respect to blood pressure, Sood A reported that the usual care group exhibited a greater improvement in systolic blood pressure with statistical differences. All other results displayed no significant statistical difference between the groups. Also, no statistical difference was found in most of the lipid profile results.

Conclusion: Our review shows that teleconsultations do not provide a clear benefit to elderly people with diabetes, but they may be non-inferior.

Keywords: Telemedicine, diabetes mellitus, elderly, systematic review, glycated hemoglobin, blood pressure, body mass index.

[1]
International diabetes federation’s diabetes atlas. Available from: https://diabetesatlas.org/en/ (Accessed on 27 June 2020).
[2]
Sever B, Altıntop MD, Demir Y, et al. Identification of a new class of potent aldose reductase inhibitors: Design, microwave-assisted synthesis, in vitro and in silico evaluation of 2-pyrazolines. Chem Biol Interact 2021; 345: 109576.
[http://dx.doi.org/10.1016/j.cbi.2021.109576] [PMID: 34252406]
[3]
Khursheed R, Singh SK, Wadhwa S, et al. Treatment strategies against diabetes: Success so far and challenges ahead. Eur J Pharmacol 2019; 862: 172625.
[http://dx.doi.org/10.1016/j.ejphar.2019.172625] [PMID: 31449807]
[4]
Akdağ M, Özçelik AB, Demir Y, Beydemir Ş. Design, synthesis, and aldose reductase inhibitory effect of some novel carboxylic acid derivatives bearing 2-substituted-6-aryloxo-pyridazinone moiety. J Mol Struct 2022; 1258: 132675.
[http://dx.doi.org/10.1016/j.molstruc.2022.132675]
[5]
Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: A systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovasc Diabetol 2018; 17(1): 83.
[6]
Pezzullo L, Streatfeild J, Simkiss P, Shickle D. The economic impact of sight loss and blindness in the UK adult population. BMC Health Serv Res 2018; 18(1): 63.
[http://dx.doi.org/10.1186/s12913-018-2836-0]
[7]
Chapman D, Foxcroft R, Dale-Harris L, Ronte H, Bidgoli F, Bellary S. Insights for care: The healthcare utilisation and cost impact of managing type 2 diabetes-associated microvascular complications. Diabetes Ther 2019; 10(2): 575-85.
[http://dx.doi.org/10.1007/s13300-018-0548-4] [PMID: 30737674]
[8]
2018 USRDS annual data report: Epidemiology of kidney disease in the United States. Bethesda: National Institutes of Health, national institute of diabetes and digestive and kidney diseases. 2018. Available from: https://www.usrds.org/2018/view/Default.aspx (Accessed on Accessed 26 June 2020).
[9]
Moxey PW, Gogalniceanu P, Hinchliffe RJ, et al. Lower extremity amputations-a review of global variability in incidence. Diabet Med 2011; 28(10): 1144-53.
[http://dx.doi.org/10.1111/j.1464-5491.2011.03279.x] [PMID: 21388445]
[10]
Bădescu SV, Tătaru C, Kobylinska L, et al. The association between Diabetes mellitus and Depression. J Med Life 2016; 9(2): 120-5.
[PMID: 27453739]
[11]
Sever B, Altıntop MD, Demir Y, et al. An extensive research on aldose reductase inhibitory effects of new 4H-1,2,4-triazole derivatives. J Mol Struct 2021; 1224: 129446.
[http://dx.doi.org/10.1016/j.molstruc.2020.129446]
[12]
McGill M, Blonde L, Chan JCN, Khunti K, Lavalle FJ, Bailey CJ. The interdisciplinary team in type 2 diabetes management: Challenges and best practice solutions from real-world scenarios. J Clin Transl Endocrinol 2016; 7: 21-7.
[http://dx.doi.org/10.1016/j.jcte.2016.12.001] [PMID: 29067246]
[13]
Gaede P, Valentine WJ, Palmer AJ, et al. Cost-effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes: Results and projections from the Steno-2 study. Diabetes Care 2008; 31(8): 1510-5.
[http://dx.doi.org/10.2337/dc07-2452] [PMID: 18443195]
[14]
Lim LL, Lau ESH, Kong APS, et al. Aspects of multicomponent integrated care promote sustained improvement in surrogate clinical outcomes: A systematic review and meta-analysis. Diabetes Care 2018; 41(6): 1312-20.
[http://dx.doi.org/10.2337/dc17-2010] [PMID: 29784698]
[15]
Zimbudzi E, Lo C, Misso ML, et al. Effectiveness of self-management support interventions for people with comorbid diabetes and chronic kidney disease: A systematic review and meta-analysis. Syst Rev 2018; 7(1): 84.
[http://dx.doi.org/10.1186/s13643-018-0748-z]
[16]
Ji L, Bonnet F, Charbonnel B, et al. Towards an improved global understanding of treatment and outcomes in people with type 2 diabetes: Rationale and methods of the DISCOVER observational study program. J Diabetes Complications 2017; 31(7): 1188-96.
[http://dx.doi.org/10.1016/j.jdiacomp.2017.03.011] [PMID: 28499961]
[17]
Yin Z, Lesser J, Paiva KA, et al. Using mobile health tools to engage rural underserved individuals in a diabetes education program in south Texas: Feasibility study. JMIR Mhealth Uhealth 2020; 8(3): e16683.
[http://dx.doi.org/10.2196/16683] [PMID: 32207694]
[18]
Sood S, Mbarika V, Jugoo S, et al. What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings. Telemed J E Health 2007; 13(5): 573-90.
[http://dx.doi.org/10.1089/tmj.2006.0073] [PMID: 17999619]
[19]
Tchero H, Kangambega P, Briatte C, Brunet-Houdard S, Retali GR, Rusch E. Clinical effectiveness of telemedicine in diabetes mellitus: A meta-analysis of 42 randomized controlled trials. Telemed J E Health 2019; 25(7): 569-83.
[http://dx.doi.org/10.1089/tmj.2018.0128] [PMID: 30124394]
[20]
Quinn CC, Khokhar B, Weed K, Barr E, Gruber-Baldini AL. Older adult self-efficacy study of mobile phone diabetes management. Diabetes Technol Ther 2015; 17(7): 455-61.
[http://dx.doi.org/10.1089/dia.2014.0341] [PMID: 25692373]
[21]
Kim HS, Yang SJ, Jeong YJ, Kim YE, Hong SW, Cho JH. Satisfaction survey on information technology-based glucose monitoring system targeting diabetes mellitus in private local clinics in Korea. Diabetes Metab J 2017; 41(3): 213-22.
[http://dx.doi.org/10.4093/dmj.2017.41.3.213] [PMID: 28657235]
[22]
Cho JH, Kim HS, Yoo SH, et al. An Internet-based health gateway device for interactive communication and automatic data uploading: Clinical efficacy for type 2 diabetes in a multi-centre trial. J Telemed Telecare 2017; 23(6): 595-604.
[http://dx.doi.org/10.1177/1357633X16657500] [PMID: 27381040]
[23]
Lee TI, Yeh YT, Liu CT, Chen PL. Development and evaluation of a patient-oriented education system for diabetes management. Int J Med Inform 2007; 76(9): 655-63.
[http://dx.doi.org/10.1016/j.ijmedinf.2006.05.030] [PMID: 16815741]
[24]
University of York: Centre for Reviews and Dissemination. PROSPERO: International prospective register of systematic reviews. Available from: https://crd.york.ac.uk/prospero/ (Accessed on Jul 2021).
[25]
Sterne JAC, Savović J, Page MJ, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898.
[26]
Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2014. Available from: http://www.ohri.ca/progra ms/clinical_epidemiology/oxford.asp (Accessed on 15 august 20).
[27]
Sood A, Watts SA, Johnson JK, Hirth S, Aron DC. Telemedicine consultation for patients with diabetes mellitus: A cluster randomised controlled trial. J Telemed Telecare 2018; 24(6): 385-91.
[http://dx.doi.org/10.1177/1357633X17704346] [PMID: 28406066]
[28]
Levin K, Madsen JR, Petersen I, Wanscher CE, Hangaard J. Telemedicine diabetes consultations are cost-effective, and effects on essential diabetes treatment parameters are similar to conventional treatment: 7-Year results from the Svendborg Telemedicine Diabetes Project. J Diabetes Sci Technol 2013; 7(3): 587-95.
[http://dx.doi.org/10.1177/193229681300700302] [PMID: 23759390]
[29]
Carallo C, Scavelli FB, Cipolla M, et al. Management of type 2 diabetes mellitus through telemedicine. PLoS One 2015; 10(5): e0126858.
[http://dx.doi.org/10.1371/journal.pone.0126858] [PMID: 25974092]
[30]
Eberle C, Stichling S. Effect of telemetric interventions on glycated hemoglobin A1c and management of type 2 diabetes mellitus: Systematic meta-review. J Med Internet Res 2021; 23(2): e23252.
[31]
‘Idosos no Brasil II: Vivências, desafios e expectativas na 3ª idade’. Pesquisas FPA. 2020. Available from: https://fpabramo.org.br/publicacoes/wp-content/uploads/sites/5/202 0/08/Pesquisa-Idosos-II-Completa-v2.pdf (Accessed 01 September 2021).
[32]
Sun X, Yan W, Zhou H, et al. Internet use and need for digital health technology among the elderly: A cross-sectional survey in China. BMC Public Health 2020; 20(1): 1386.
[http://dx.doi.org/10.1186/s12889-020-09448-0] [PMID: 32917171]
[33]
Gordon NP, Hornbrook MC. Older adults' readiness to engage with eHealth patient education and self-care resources: A cross-sectional survey. BMC Health Serv Res 2018; 18(1): 220.
[34]
Diniz JL, Moreira ACA, Teixeira IX, Azevedo SGV, Freitas CASL, Maranguape IC. Digital inclusion and Internet use among older adults in Brazil: A cross-sectional study. Rev Bras Enferm 2020; 73 (Suppl. 3): e20200241.
[http://dx.doi.org/10.1590/0034-7167-2020-0241] [PMID: 33174998]
[35]
‘Report: 22 Million U.S. Seniors lack broadband internet access; First time study quantifies digital isolation of older Americans as pandemic continues to ravage nation’. 2021.Business Wire Available from: https://www.businesswire.com/news/home/20210127005243/en/Report-22-Million-U.S.-Seniors-Lack-Broadband-Internet-Access-First-Time-Study-Quantifies-Digital-Isolation-of-Older-Americans-as-Pandemic-Continues-to-Ravage-Nation (Accessed on 01 September 2021).
[36]
Magliah SF, Alsabban AS, Turkistani HA, et al. Perception of virtual clinics among Saudi adults with type 1 diabetes during the COVID-19 pandemic. Diabetes Metab Syndr 2021; 15(4): 102175.
[http://dx.doi.org/10.1016/j.dsx.2021.06.012] [PMID: 34186374]
[37]
Gomes-de Almeida S, Marabujo T, do Carmo-Gonçalves M. Telemedicine satisfaction of primary care patients during COVID-19 pandemics. Semergen 2021; 47(4): 248-55.
[http://dx.doi.org/10.1016/j.semerg.2021.01.005] [PMID: 33781673]
[38]
Robson N, Hosseinzadeh H. Impact of telehealth care among adults living with type 2 diabetes in primary care: A systematic review and meta-analysis of randomised controlled trials. Int J Environ Res Public Health 2021; 18(22): 12171.
[http://dx.doi.org/10.3390/ijerph182212171] [PMID: 34831925]
[39]
Hangaard S, Laursen SH, Andersen JD, et al. The effectiveness of telemedicine solutions for the management of type 2 diabetes: A systematic review, meta-analysis, and meta-regression. J Diabetes Sci Technol 2021; 19322968211064633.
[http://dx.doi.org/10.1177/19322968211064633] [PMID: 34957864]
[40]
Udsen FW, Hangaard S, Bender C, et al. The effectiveness of telemedicine solutions in type 1 diabetes management: A systematic review and meta-analysis. J Diabetes Sci Technol 2022; 19322968221076874.
[http://dx.doi.org/10.1177/19322968221076874] [PMID: 35135365]
[41]
Eberle C, Loehnert M, Stichling S. Effectivness of specific mobile health applications (mHealth-apps) in gestational diabtetes mellitus: A systematic review. BMC Pregnancy Childbirth 2021; 21(1): 808.
[http://dx.doi.org/10.1186/s12884-021-04274-7] [PMID: 34865645]
[42]
Varela-Moreno E, Carreira Soler M, Guzmán-Parra J, Jódar-Sánchez F, Mayoral-Cleries F, Anarte-Ortíz MT. Effectiveness of eHealth-based psychological interventions for depression treatment in patients with type 1 or type 2 diabetes mellitus: A systematic review. Front Psychol 2022; 12: 746217.
[http://dx.doi.org/10.3389/fpsyg.2021.746217] [PMID: 35173644]