The Impact of Telemedicine Interventions Involving Routine Transmission of Blood Glucose Data with Clinician Feedback on
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Research Article The Impact of Telemedicine Interventions Involving Routine Transmission of Blood Glucose Data with Clinician Feedback on Metabolic Control in Youth with Type 1 Diabetes: A Systematic Review and Meta-Analysis Rayzel M. Shulman, Clodagh S. O’Gorman, and Mark R. Palmert Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada M5G 1X8 Correspondence should be addressed to Rayzel M. Shulman, [email protected] Received 18 May 2010; Accepted 13 July 2010 Academic Editor: Stuart A. Weinzimer Copyright © 2010 Rayzel M. Shulman et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Our objective was to determine the impact of telemedicine (TM) interventions on the management of type 1 diabetes (T1DM) in youth. We performed a systematic review of randomized trials that evaluated TM interventions involving transmission of blood glucose data followed by unsolicited scheduled clinician feedback. We found no apparent effect of the TM interventions on hemoglobin A1c (HbA1c), severe hypoglycemia, or diabetic ketoacidosis. The limited data available on patient satisfaction, quality of life, and cost also suggested no differences between groups. It is unlikely that TM interventions, as performed in the assessed studies, had a substantial effect on glycemic control or acute complications. However, it remains possible that there are other benefits of TM not adequately reported, that newer TM strategies may be more effective and that interventions may benefit subgroups of youth, such as those with the poor glycemic control, adolescents, or those living in remote areas.
1. Introduction Intensive glycemic control delays and prevents microvascular and macrovascular complications of type 1 diabetes (T1DM) [1, 2]. Despite advances in insulin preparations and delivery mechanisms for insulin, glycemic control for many pediatric patients with T1DM remains suboptimal. An international study comparing glycemic control among pediatric diabetes centres failed to show a correlation with insulin regimen, suggesting that other factors, such as the organization of delivery of care and the number of staff on the diabetes team, may be critical to attaining optimal blood glucose control [3]. The intensive treatment protocol used in the Diabetes Control and Complications Trial (DCCT) included telephone contacts to adjust insulin regimens daily for the first week and then weekly thereafter. The intervention also involved an intensive insulin regimen, increased frequency
of clinic visits, and intensive blood glucose monitoring [4]. Although shown to be effective in improving glycemic control, these intensive measures are not feasible to carry out in routine practice. Moreover, the particular challenges presented by youth with T1DM necessitate innovative management strategies [5].
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