Effectiveness of Telemedicine-Delivered Carbohydrate Counting Interventions in Patients with Type 1 Diabetes: A Systematic Review and Meta-analysis

J Med Internet Res. 2025 Feb 11. doi: 10.2196/59579. Online ahead of print.

ABSTRACT

BACKGROUND: Type 1 diabetes mellitus (T1DM) significantly affects patients' quality of life and could lead to death; its monitoring needs to be improved. Telemedicine uses telecommunications technologies to provide patients with health services, expertise, and information, which could enhance T1DM care; however, its effectiveness is yet to be proven.

OBJECTIVE: This study aimed to investigate the effectiveness of different telemedicine approaches for carbohydrate-counting (CC) interventions in patients with T1DM.

METHODS: This systematic review and meta-analysis study searched five databases, including PubMed, Web of Science, CINAHL, Embase, and Cochrane, and the reference articles retrieved on September 26, 2024, for randomised controlled trials (RCTs); these trials evaluated the effectiveness of a telemedicine-based CC intervention in lowering glycated haemoglobin A1c (HbA1c) levels in patients with T1DM.

RESULTS: Results: From 3,612 citations, we identified 18 eligible randomised controlled trials (n = 1,627) from 14 regions for inclusion in the meta-analysis. Participants in the telemedicine intervention group experienced a 0.35% reduction in HbA1c level (95% CI [-0.54 to -0.16]) compared with those in the control group. Thirteen studies used smartphone applications as the primary delivery method for telemedicine intervention, four used connected and wearable glucometers, and three delivered the intervention through web-based systems. When the intervention was delivered via smartphone apps (-0.36% [-0.63 to -0.09]), connected and wearable glucose meters (-0.35% [-0.56 to -0.14]), or web-based systems (-0.36% [-0.71 to -0.02]), the between-group reduction was significant. Considerable heterogeneity was observed between the studies (I2 = 81%, p <.01). Telemedicine-based CC interventions led to an increase in TIR of (9.59% [6.50 to 12.67]). However, evidence related to treatment satisfaction, the total daily insulin dose, or hypoglycaemia remains inconclusive. In the subgroup analysis, the variety of telemedicine platforms did not significantly contribute to heterogeneity. In the meta-regression analysis, telemedicine's impact on HbA1c was most pronounced in trials conducted in Asia.

CONCLUSIONS: Compared with usual care, telemedicine-delivered CC interventions improved HbA1c and TIR but not other clinically relevant patient outcomes in patients with T1DM. However, high-quality, more extensive RCTs are required to draw definitive conclusions. Our findings could provide healthcare professionals with up-to-date evidence on the effect of telemedicine on glycaemic control in patients with T1DM.

CLINICALTRIAL: The study was prospectively registered in PROSPERO (CRD42024523025).

PMID:39965802 | DOI:10.2196/59579