Telemedicine in improving glycemic control among children and adolescents with type 1 diabetes mellitus: A systematic review and meta-analysis (Preprint)

Type 1 diabetes mellitus (T1DM) is the most common chronic autoimmune disease among children and adolescents. Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve the health of patients. It has been widely used in the field of chronic disease management and brings the gospel to patients with T1DM. This study aims to systematically review the evidence on the effectiveness of telemedicine intervention compared with usual care on glycemic control among children and adolescents with T1DM. In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Embase, Web of Science (all databases), and CINAHL Complete from database inception to May 2023. We included randomized controlled trials that evaluated the effectiveness of a telemedicine intervention on glycemic control in children and adolescents with T1DM. Two independent reviewers performed the study selection and data extraction. Study quality was assessed using the Cochrane risk-of-bias tool 2.0. Our primary outcome was HbA1c levels. Secondary outcomes were quality of life (QOL), self-monitoring of blood glucose (SMBG), the incidence of hypoglycemia, and cost-effectiveness. The random effects model was used for this meta-analysis. In total, 20 randomized controlled trials (1704 participants from 12 countries) were included in the meta-analysis. Only one study was at high risk of bias. Compared to usual care, telemedicine was found to reduce HbA1c by 0.21% (95% CI –0.33 to –0.09; p<.001; I2=33.9%). There was an improvement in SMBG (MD 0.54; 95% CI –0.72 to 1.80; p=.045; I2=67.8%) and the incidence of hypoglycemia (MD –0.15; 95% CI –0.57 to 0.27; p=.017; I2=70.7%), although this was not statistically significant. Moreover, telemedicine also had no convincing effect on the DQOLY (Impact of diabetes p=59; Worries about diabetes: p=.71; Satisfaction with diabetes: p=.68) and the N-QOL (p=.054). Subgroup analyses revealed that the effect of telemedicine of on HbA1c appeared to be greater in studies involving children (MD –0.41; 95% CI –0.62 to –0.20; p<.001), in studies that lasted less than six months (MD –0.32; 95% CI –0.48 to –0.17; p<.001), in studies where providers used smartphone applications to communicate with patients (MD –0.36; 95% CI –0.52 to –0.21; p<.001), and in studies with medication dose adjustment (MD –0.25; 95% CI –0.37 to –0.12; p<.001). This study has shown that telemedicine is an efficacious and safe treatment approach for children and adolescents with T1DM, leading to reduced HbA1c levels for children and adolescents with T1DM. Further research is needed to validate the effectiveness of telemedicine on the quality of life of children and adolescents and to measure the cost-effectiveness of telemedicine applications among children and adolescents with T1DM. PROSPERO International Prospective Register of Systematic Reviews CRD42023423882; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=423882