Telemedicine interventions for gestational diabetes mellitus: A systematic review and meta-analysis

  • Tshepo M Rasekaba
    Correspondence
    Corresponding author at: Department of General Practice, School of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 200 Berkeley Street, Carlton 3053, VIC, Australia. Tel.: +61 3 9035 5018; fax: +61 3 9347 6136.
    Affiliations
    Department of General Practice, The University of Melbourne, Parkville, VIC, Australia

    Northern Clinical Research Centre, The Northern Hospital, Epping, VIC, Australia
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  • John Furler
    Affiliations
    Department of General Practice, The University of Melbourne, Parkville, VIC, Australia
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  • Irene Blackberry
    Affiliations
    Department of General Practice, The University of Melbourne, Parkville, VIC, Australia

    John Richards Initiative, La Trobe University, Wodonga, VIC, Australia
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  • Mark Tacey
    Affiliations
    Northern Clinical Research Centre, The Northern Hospital, Epping, VIC, Australia

    Melbourne EpiCentre, The Royal Melbourne Hospital, Parkville, Australia
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  • Kathleen Gray
    Affiliations
    Health and Biomedical Informatics Centre, The University of Melbourne, Parkville, VIC, Australia
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  • Kwang Lim
    Affiliations
    Northern Clinical Research Centre, The Northern Hospital, Epping, VIC, Australia

    Department of Medicine, The University of Melbourne, Parkville, VIC, Australia

    Department of Medicine, The Northern Hospital, Epping, VIC, Australia
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      Highlights

      • We performed a systematic review of telemedicine for gestational diabetes mellitus.
      • Studies are few, underpowered and do not cover cost evaluation.
      • Telemedicine may reduce the need for face-to-face consultations and appointment times.
      • Findings suggest no compromise to maternal and foetal care quality and safety.
      • But definitive trials that include cost analysis are needed.

      Abstract

      Objective

      To evaluate the effect of telemedicine on GDM service and maternal, and foetal outcomes.

      Methods

      A systematic review and meta-analysis of randomised controlled trials (RCT) of telemedicine interventions for GDM was conducted. We searched English publications from 01/01/1990 to 31/08/2013, with further new publication tracking to June 2015 on MEDLINE, EMBASE, PUBMED, CINAHL, the Cochrane Central Register of Controlled Trials and the World Health Organization International Clinical Trials Registry electronic databases. Findings are presented as standardised mean difference (SMD) and odds ratios (OR) or narrative and quantitative description of findings where meta-analysis was not possible.

      Results

      Our search yielded 721 abstracts. Four met the inclusion criteria; two publications arose from the same study, resulting in three studies for review. All studies compared telemedicine to usual care. Telemedicine was associated with significantly fewer unscheduled GDM clinic visits, SMD. Quality of life, glycaemic control (HbA1c, pre and postprandial blood glucose level (BGL)), and caesarean section rate were similar between the telemedicine and usual care groups. None of the studies evaluated costs.

      Conclusions

      Telemedicine has the potential to streamline GDM service utilisation without compromising maternal and foetal outcomes. Its advantage may lie in the convenience of reducing face-to-face and unscheduled consultations. Studies are limited and more trials that include cost evaluation are required.

      Keywords

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      References

        • Jimenez-Moleon J.
        • et al.
        Prevalence of gestational diabetes mellitus: variations related to screening strategy used.
        Eur J Endocrinol. 2002; 146: 831-837
        • Wong V.W.
        • Jalaludin B.
        Gestational diabetes mellitus: who requires insulin therapy?.
        Aust N Z J Obstet Gynaecol. 2011; 51: 432-436
        • Metzger B.E.
        • et al.
        Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus.
        Diabetes Care. 2007; 30: S251-S260
        • Crowther C.A.
        • et al.
        Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.
        N Engl J Med. 2005; 352: 2477-2486
        • Landon M.B.
        • Gabbe S.G.
        Gestational diabetes mellitus.
        Obstet Gynecol. 2011; 118: 1379-1393
        • Moses R.G.
        • et al.
        The impact of potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia.
        Med J Aust. 2011; 194: 338-340
        • Hoffman L.
        • et al.
        Gestational diabetes mellitus—management guidelines. The Australasian diabetes in pregnancy society.
        Med J Aust. 1998; 169: 93-97
        • Cheung N.W.
        • Byth K.
        Population health significance of gestational diabetes.
        Diabetes Care. 2003; 26: 2005-2009
        • Kwak S.H.
        • et al.
        Clinical and genetic risk factors for type 2 diabetes at early or late post partum after gestational diabetes mellitus.
        J Clin Endocrinol Metab. 2013; 98: E744-E752
        • Bellamy L.
        • et al.
        Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis.
        Lancet. 2009; 373: 1773-1779
        • May C.
        • Montori V.M.
        • Mair F.S.
        We need minimally disruptive medicine.
        BMJ. 2009; 339: b2803
        • Fineberg H.V.
        A successful and sustainable health system—how to get there from here.
        N Engl J Med. 2012; 366: 1020-1027
        • Craig J.
        • Patterson V.
        Introduction to the practice of telemedicine.
        J Telemed Telecare. 2005; 11: 3-9
        • World Health Organization
        Lashley K. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth, Global observatory for eHealth series, 2. World Health Organization, Geneva2010
        • Wootton R.
        Twenty years of telemedicine in chronic disease management—an evidence synthesis.
        J Telemed Telecare. 2012; 18: 211-220
        • Jaana M.
        • Paré G.
        Home telemonitoring of patients with diabetes: a systematic assessment of observed effects.
        J Eval Clin Pract. 2007; 13: 242-253
        • McLean S.
        • et al.
        Telehealthcare for asthma.
        Cochrane Database Sys Rev. 2010; https://doi.org/10.1002/14651858.CD007717.pub2
        • Whittaker R.
        • et al.
        Mobile phone-based interventions for smoking cessation.
        Cochrane Database Sys Rev. 2012; https://doi.org/10.1002/14651858.CD006611.pub3
        • Whitten P.S.
        • et al.
        Systematic review of cost effectiveness studies of telemedicine interventions.
        BMJ. 2002; 324: 1434-1437
        • Thaker D.A.
        • et al.
        Cost savings from a telemedicine model of care in northern Queensland Australia.
        Med J Aust. 2013; 199: 414-417
        • Levin K.
        • et al.
        Telemedicine diabetes consultations are cost-effective, and effects on essential diabetes treatment parameters are similar to conventional treatment: 7-year results from the Svendborg Telemedicine Diabetes Project.
        J Diabetes Sci Technol. 2013; 7: 587-595
        • Dalfra M.G.
        • Nicolucci A.
        • Lapolla A.
        The effect of telemedicine on outcome and quality of life in pregnant women with diabetes.
        J Telemed Telecare. 2009; 15: 238-242
        • Liberati A.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
        • Downs S.
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodolgical quality both of randomised and non-randomised studies of health care interventions.
        J Epidemiol Commun Health. 1998; 52: 377-384
        • The Cochrane Collaboration
        Review Manager (RevMan 5.3).
        The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen2014
        • Higgins J.P.
        • et al.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Kruger D.F.
        • et al.
        Effect of modem transmission of blood glucose data on telephone consultation time, clinic work flow, and patient satisfaction for patients with gestational diabetes mellitus.
        J Am Acad Nurse Practitioners. 2003; 15: 371-375
        • Bartholomew M.L.
        • et al.
        Managing diabetes in pregnancy using cell phone/internet technology.
        Am J Obstet Gynecol. 2011; 204: S113-S114
        • Ferrara A.
        • et al.
        A pregnancy and postpartum lifestyle intervention in women with gestational diabetes mellitus reduces diabetes risk factors: a feasibility randomized control trial.
        Diabetes care. 2011; 34: 1519-1525
        • Reinhardt J.A.
        • et al.
        lmplementing lifestyle change through phone-based motivational interviewing in rural-based women with previous gestational diabetes mellitus.
        Health Promotion J Aust. 2012; 23 (official journal of Australian Association of Health Promotion Professionals): 5-9
        • Ferrara A.
        • et al.
        Referral to telephonic nurse management improves outcomes in women with gestational diabetes.
        Am J Obstet Gynecol. 2012; 206 (p. 491): e1-e5
        • Klonoff D.C.
        • True M.W.
        The Missing Element of Telemedicine for Diabetes: Decision Support Software.
        J Diabetes Sci Technol. 2009; 3: 996-1001
        • Hernando M.E.
        • et al.
        Evaluation of DIABNET, a decision support system for therapy planning in gestational diabetes.
        Comput Methods Programs Biomed. 2000; 62: 235-248
        • Vadheim L.M.
        • et al.
        Adapted diabetes prevention program lifestyle intervention can be effectively delivered through telehealth.
        Diabetes Educator. 2010; 36: 651-656
        • Lewis B.A.
        • et al.
        A pilot study evaluating a telephone-based exercise intervention for pregnant and postpartum women.
        J Midwifery Womens Health. 2011; 56: 127-131
        • Dalfra M.G.
        • et al.
        The effect of telemedicine on outcome and quality of life in pregnant women with diabetes.
        J Telemed Telecare. 2009; 15: 238-242
        • Homko C.J.
        • et al.
        Impact of a telemedicine system with automated reminders on outcomes in women with gestational diabetes mellitus.
        Diabetes Technol Ther. 2012; 14: 624-629
        • Homko C.J.
        • et al.
        Use of an internet-based telemedicine system to manage underserved women with gestational diabetes mellitus.
        Diabetes Technol Ther. 2007; 9: 297-306
        • Pérez-Ferre N.
        • et al.
        A Telemedicine system based on internet and short message service as a new approach in the follow-up of patients with gestational diabetes.
        Diabetes Res Clin Pract. 2010; 87: pe15-pe17
        • Perez-Ferre N.
        • et al.
        The outcomes of gestational diabetes mellitus after a telecare approach are not inferior to traditional outpatient clinic visits.
        Int J Endocrinol. 2010; 2010 (Article ID 386941): 1-6
        • Buysse H.
        • et al.
        Main characteristics of type 1 and type 2 diabetic patients interested in the use of a telemonitoring platform.
        J Nursing Healthcare Chronic Illnesses. 2011; 3: 456-468
        • Copas J.
        • Shi J.Q.
        Meta-analysis, funnel plots and sensitivity analysis.
        Biostatistics. 2000; 1: 247-262