Table 2. Summary of the included studies.

V-IMPACT: virtual integrated multisite patient aligned care teams; DCN: diabetes care network; DC: diabetes consultation; DSME: diabetes self-management education; SMBG: structured self-monitoring of blood glucose; BGM: blood glucose meter; ACDC: advanced comprehensive diabetes care

Author and Year	Intervention	Sample Size	Gender	Mean Age	Rurality	Study Design	Results	Conclusion
Baum et al., 2023 [19]	Pharmacist-provided telehealth diabetes management for veterans	522	-	-	76.6%	Retrospective chart review	72% maintained HbA1c control, 12.2% improved HbA1c, 15.7% worsened HbA1c.	Glycemic control was maintained or improved in 84.2% of patients, demonstrating the effectiveness of telehealth in reaching rural veterans.
Davis et al., 2019 [24]	Telehealth for chronic care management in a rural setting	115	Males: 31% Females: 69%	53.6 ± 11.9	100%	Prospective, longitudinal cohort study	Mean HbA1c reduced significantly from 9.5% to 7.9% (p < 0.001).	Telehealth and remote patient monitoring are effective tools for improving diabetes management and outcomes in rural populations, demonstrating feasibility and benefits in underserved areas.
Lu et al., 2021 [20]	The V-IMPACT program utilized videoconferencing to connect rural veterans with primary care providers	9010	Males: 96% Females: 4.4%	68.4 ± 10.3	75%	Retrospective cohort study	HbA1c reduction: V-IMPACT group (-0.055%, 95% CI: -0.065 to -0.045) vs. Usual care (-0.047%, 95% CI: -0.057 to -0.037). Significant increases in statin and ACE/ARB prescriptions, and yearly microalbuminuria testing in the intervention group (p < 0.01).	There were no differences in HbA1c. The quality of diabetes care delivered through the V-IMPACT virtual primary care model was similar to, if not better than, traditional in-person care, especially in terms of medication management and testing compliance.
Robinson et al., 2021 [21]	Secure Messaging in a patient portal	1000	Males: 94 % Females: 6 %	66.4 ± 7.7	51%	Retrospective observational, mixed-methods	Increased secure messaging use was associated with higher odds of achieving HbA1c control (OR = 1.5, 95% CI: 1.2 to 1.8).	Secure messaging can be an effective tool for diabetes self-management, especially in rural populations with limited access to in-person care. This can help in achieving better glycemic control through better communication and support.
Zupa et al., 2022 [13]	Diabetes Care Network (DCN) program for remote diabetes management in rural settings	87	Males: 97.7% Females: 2.3%	67.2 ± 8.35	100%	Prospective cohort study	Significant reduction in HbA1c levels: Erie cohort (-3.03%), Butler cohort (-2.06%).	DCN model effectively improved glycemic control and other clinical outcomes in rural Veterans with type 2 diabetes, demonstrating the feasibility of remote, team-based diabetes specialty care in rural populations.
Zupa et al., 2023 [22]	Telemedicine for endocrinology care in a rural and urban setting	3778	Males: 42% Females: 58%	60.3 ± 12.7	8%	Retrospective cohort study	Telemedicine-only Group: Mean HbA1c Change: -0.06% (no significant change) In-person Care Group: Mean HbA1c Change: -0.37% (95% CI: -0.43 to -0.31, p < 0.001) Mixed Care Group: Mean HbA1c Change: -0.22% (95% CI: -0.28 to -0.16, p < 0.001).	Patients using telemedicine alone had worse glycemic outcomes compared to those using in-person or mixed-care. Among the 297 rural patients, those using telemedicine alone showed no significant HbA1c changes. However, significant HbA1c improvements were seen in rural patients who transitioned to in-person or mixed-care models.
Eiland et al., 2022 [23]	Traditional telehealth visits for endocrinology care in rural settings	139	Females: 57.6% Males: 42.4%	44.5 ± 16.0	100%	Retrospective cohort study	Statistically significant decline in HbA1c, the mean initial HbA1c was 8.4%, and it reduced to 8.0% at the final visit.	Traditional telehealth visits effectively provided long-term care for people with T1D in rural areas, improving glycemic outcomes and demonstrating the potential to remove barriers to care.
Nyenwe et al., 2020 [25]	DC by an endocrinologist vs. DSME by a certified diabetes educator delivered via telemedicine	69	Males: 30% Females: 70%	56.6 ± 8.0	100%	Prospective cohort study	HbA1c reduced from 9.3% to 7.2% in the DC group (p = 0.0002) and from 9.8% to 8.3% in the DSME group (p = 0.009).	Both DC and DSME via telemedicine significantly improved glycemic control in patients with poorly controlled diabetes from rural communities, demonstrating the effectiveness of telemedicine in underserved populations.
Han et al., 2023 [18]	Telemedicine-assisted SMBG vs. traditional BGM in rural areas	418	Males: 45% Females: 55%	52.1 ± 9.2	100%	Open-label randomized clinical trial	HbA1c reduced significantly in the intervention group (7.95% to 7.38%, p < 0.001) but not in the control group (8.03% to 7.98%, p = 0.38).	Telemedicine-assisted structured SMBG significantly improved glycemic control, reduced hypoglycemia risk, and enhanced self-management in rural T2DM patients.
Kobe et al., 2022 [26]	ACDC program, a telehealth intervention for clinic-refractory, uncontrolled T2D in rural areas	230	Males: 95% Females: 5%	59.4 ± 1.1	63%	Mixed-methods implementation study	Mean HbA1c reduced from 9.56% to 8.14% at 6 months, with sustained improvements at 12 and 18 months (p < 0.001).	ACDC significantly improved glycemic control in a previously refractory population, demonstrating the feasibility and effectiveness of comprehensive telehealth interventions in rural areas.