Table 5.

Effectiveness of telemedicine on glycated hemoglobin in patients with diabetes, according to population characteristics.

Category of application and type of diabetes		Population characteristics	Trials, n	Patients, n	Outcome	MDa (95% CI) of percent change in HbA1cb	P value	I2 (%)	Grading of Recommendations, Assessment, Development, and Evaluation
Telemedicine [70,85]
	T1Dc	Adults	15	1256	d,e	−0.26 (−0.47 to −0.05)	<.01	79.7
	T1D	Children and adolescents	11	796		−0.12 (−0.30 to 0.05)	.70	0
	T1D	Baseline HbA1c <9.0%	16	NS		−0.06 (−0.02 to 0.09)	NSf	NS
	T1D	Baseline HbA1c ≥9.0%	12	NS		−0.34 (−0.57 to −0.11)	NS	NS
	T2Dg	Baseline HbA1c <8.0%	48	5720		−0.22 (−0.25 to −0.19)	NS	NS
	T2D	Baseline HbA1c ≥8.0%	45	8100		−0.60 (−0.61 to −0.60)	NS	NS
Digital self-management [60-62,68,72,79,83]
	T2D	Age <55 years	7	701		−0.67 (−1.15 to −0.20)	.52	75
	T2D	Age ≥55 years	8	541		−0.41 (−0.62 to −0.21)	.52	0
	T2D	Age undetermined	2	289		−0.72 (−1.60 to 0.16)	.52	47
	T2D	Diagnosish <8.5 years ago	7	549		−0.83 (−1.10 to 0.56)	.007	0
	T2D	Diagnosish ≥8.5 years ago	4	394		−0.22 (−0.44 to 0.01)	.007	0
	T2D	Diagnosis timeh undetermined	6	588		−0.43 (−0.71 to −0.30)	.007	55
	T2D	Baseline HbA1c ≤8.0%	6	590		−0.49 (−0.71 to −0.27)	.69	0
	T2D	Baseline HbA1c ≤8.0%	7	NS		−0.33 (−0.53 to −0.13)	<.05	46
	T2D	Baseline HbA1c >7.0%	11	1707		−0.33 (−0.48 to −0.18)	<.001	77.8
	T2D	Baseline HbA1c >7.5%	10	1921		−0.45 (−0.70 to −0.21)	<.001	80.4
	T2D	Baseline HbA1c >8.0%	11	941		−0.57 (−0.93 to −0.22)	.69	65
	T2D	Baseline HbA1c >8.0%	11	NS		−0.70 (−1.03 to −0.36)	<.05	81
	T2D	Baseline BMI <30 kg/m2	5	359		−0.64 (−0.91 to −0.36)	.49	0
	T2D	Baseline BMI ≥30 kg/m2	10	966		−0.43 (−0.68 to −0.17)	.49	35
	T2D	Baseline BMI undetermined	2	206		−0.96 (−2.76 to 0.85)	.49	91
	T1D/T2D	Age <40 years	14	NS		−0.32	.02	NS
	T1D/T2D	Age <40 years	11	NS		−0.85 (−1.79 to 0.10)	.07	98
	T1D/T2D	Age ≥40 years	40	NS		−0.53	<.001	NS
	T1D/T2D	Age 41-50 years	8	NS		−1.83 (−3.17 to −0.48)	<.001	96.2
	T1D/T2D	Age >50 years	17	NS		−1.05 (−1.50 to −0.60)	<.001	97
	T1D/T2D	Baseline HbA1c <8.0%	6	NS		−0.26 (−0.43 to −0.10)	.03	NS
	T1D/T2D	Baseline HbA1c ≥ 8.0%	8	NS		−0.64 (−0.93 to −0.35)	.03	NS
	T1D/T2D	Baseline HbA1c <9.0%	NS	NS		−0.35	NS	NS
	T1D/T2D	Baseline HbA1c ≥9.0%	NS	NS		−1.22	NS	NS
Digital self-management (mobile health) [66,84]
	T2D	Baseline HbA1c <8.0%	4	696		−0.33 (−0.59 to −0.06)	.02	70
	T1D/T2D	Average age <25 years	5	NS		−0.5 (−0.8 to −0.1)	.54	NS
	T1D/T2D	Average age ≥25 years	17	NS		−0.5 (−0.7 to −0.3)	.54	NS
	T1D/T2D	BMI ≥25 kg/m2	7	NS		−0.8 (−1.1 to −0.5)	.93	NS
	T1D/T2D	24 kg/m2≤ BMI <25 kg/m2	3	NS		−0.8 (−1.7 to 0.1)	.93	NS
	T1D/T2D	BMI unspecified	12	NS		−0.3 (−0.5 to −0.1)	.93	NS
Digital self-management (SMS) [75]
	T2D	Age <55 years	5	NS		−0.65 (−0.88 to −0.41)	<.001	NS
	T2D	Age ≥55 years	5	NS		−0.42 (−0.56 to −0.27)	.006	NS
	T2D	Diagnosish <7 years ago	4	NS		−0.61 (−0.79 to −0.42)	.001	NS
	T2D	Diagnosish ≥7 years ago	3	NS		−0.37 (−0.62 to −0.13)	.031	NS
	T2D	Baseline HbA1c <8.0%	5	NS		−0.71 (−0.93 to −0.48)	<.001	NS
	T2D	Baseline HbA1c ≥8.0%	5	NS		−0.38 (−0.53 to −0.24)	<.001	NS

^aMD: mean difference.

^bHbA_1c: glycated hemoglobin.

^cT1D: type 1 diabetes.

^dThe direction of the arrows indicates potential clinically relevant reduction rates (see Table 2).

^eGreen arrows show statistical significance.

^fNS: not specified—cases in which no data were provided. Missing data on statistical significance were handled as nonsignificant.

^gT2D: type 2 diabetes.

^hDiagnosis time: time since first diagnosis of diabetes.