Distal technology interventions in people with diabetes: an umbrella review of multiple health outcomes. Issue 12 (12th November 2019)

• Record Type: Journal Article
• Authors: Chakranon, P.; Lai, Y. K.; Tang, Y. W.; Choudhary, P.; Khunti, K.; Lee, S. W. H.
• Is Part Of: Diabetic medicine. Volume 37:Issue 12(2020)
• Page Start: 1966
• Page End: 1976
• Publication Date: 2019-11-12
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.14156
• Languages: English
• ISSNs: 0742-3071

Abstract

What's new?: Our umbrella review showed that in a large number of systematic review and meta‐analyses, distal technology leads to improvement only in HbA1c levels. The evidence to support distal technology use for other outcomes, such as blood pressure, lipids and patient‐reported outcomes, was weak. Most distal technologies for diabetes care are used in silo and not in synchronization with healthcare systems. There is a need to connect up these distal technologies (e.g. glucometers, activity counters, apps) to fully realise their clinical potential. Abstract: 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.