Key result
Remotely delivered interventions significantly reduced HbA1c (SMD -0.25), total cholesterol, LDL-cholesterol, and systolic and diastolic blood pressure compared to usual care in people with diabetes.
Why the study?
Remotely delivered interventions may be more efficient in controlling multiple risk factors in people with diabetes, but pooled evidence was needed.
Do remotely delivered interventions improve HbA1c, total cholesterol, LDL-c, and blood pressure in people with diabetes compared to usual care?
Meta-Analysis (n=9,100)
Do remotely delivered interventions improve HbA1c, total cholesterol, LDL-c, and blood pressure in people with diabetes compared to usual care?
Standardized Mean Difference: -0.25 (95% CI -0.33–-0.17)
p-value: p=<0.001
Remotely delivered interventions significantly improve the control of HbA1c, blood pressure, and lipids in patients with diabetes compared to usual care.
Supports broader adoption of remote interventions in diabetes care; reinforces meta-analytic evidence for cardiometabolic risk reduction.
Background: Remotely delivered interventions may be more efficient in controlling multiple risk factors in people with diabetes. Purpose: To pool evidence from randomized controlled trials testing remote management interventions to simultaneously control blood pressure, blood glucose and lipids. Data Sources: June 2021. Study Selection: Included RCTs were those that reported participant data on blood pressure, blood glucose, and lipid outcomes in response to a remotely delivered intervention. Data Extraction: Three authors extracted data using a predefined template. Primary outcomes were glycated hemoglobin (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), systolic and diastolic blood pressure (SBP & DBP). Risk of bias was assessed using the Cochrane collaboration RoB-2 tool. Meta-analyses are reported as standardized mean difference (SMD) with 95% confidence intervals (95%CI). Data Synthesis: Twenty-seven RCTs reporting on 9100 participants (4581 intervention and 4519 usual care) were included. Components of the remote management interventions tested were identified as patient education, risk factor monitoring, coaching on monitoring, consultations, and pharmacological management. Comparator groups were typically face-to-face usual patient care. Remote management significantly reduced HbA1c (SMD -0.25, 95%CI -0.33 to -0.17, p<0.001), TC (SMD -0.17, 95%CI -0.29 to -0.04, p<0.0001), LDL-c (SMD -0.11, 95%CI -0.19 to -0.03, p=0.006), SBP (SMD -0.11, 95%CI -0.18 to -0.04, p=0.001) and DBP (SMD -0.09, 95%CI -0.16 to -0.02, p=0.02), with low to moderate heterogeneity (I²= 0 to 75). Twelve trials had high risk of bias, 12 had some risk and three were at low risk of bias. Limitations: Heterogeneity and potential publication bias may limit applicability of findings. Conclusions: Remote management significantly improves control of modifiable risk factors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258433], identifier PROSPERO (CRD42021258433).
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Fernando et al. (2022) conducted a meta-analysis in Diabetes (Type 1 or Type 2) (n=9,100). Remotely delivered interventions (education, monitoring, coaching, consultations, pharmacological management) vs. Usual care was evaluated on Glycated hemoglobin (HbA1c) (SMD -0.25, 95% CI -0.33 to -0.17, p=<0.001). Remotely delivered interventions significantly reduced HbA1c (SMD -0.25), total cholesterol, LDL-cholesterol, and systolic and diastolic blood pressure compared to usual care in people with diabetes.
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