Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis

Objective To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. Methods We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties. Findings We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of -0.38 for glycated haemoglobin (95% confidence interval, CI: -0.52 to -0.23; I-2 = 86.70%), -0.20 for fasting blood sugar (95% CI: -0.32 to -0.08; I-2 = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I-2 = 93.75%), 0.55 for diabetes knowledge (95% CI: -0.10 to 1.20; I-2 = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I-2 = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of -0.04 for body mass index (95% CI: -0.13 to 0.05; I-2 = 35.94%), -0.06 for total cholesterol (95% CI: -0.16 to 0.04; I-2 = 59.93%) and -0.02 for triglycerides (95% CI: -0.12 to 0.09; I-2 = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications. Conclusion Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.

Automated summary

The meta-analysis of 31 interventions showed that telemedicine has significant positive effects on improving glycated hemoglobin, fasting blood sugar, treatment adherence, diabetes knowledge, and self-efficacy in low- and middle-income countries. Phone and SMS interventions were found to be more effective than telemetry and smartphone-based services. However, due to heterogeneity and risk of bias, the certainty of evidence was deemed very low.