Telemonitoring interventions for the clinical management of type one diabetic children and adolescents: systematic review and meta-analysis of randomised control trials

Abstract

Abstract Background The incidence of type 1 diabetes in children and adolescents has risen recently. The disease management is challenging among this age group due to hormonal, emotional and social factors. However, telehealth has shown promising results after conducting several types of intervention, but the direct telemonitoring for the patient regular blood glucose measurements and other parameter has not been evaluated. Method A systematic review was conducted. RCTs were sought in MEDLINE, Embase, CINHAL, and Central (1999-2021). The Cochrane Risk of Bias tool was used to assess studies bias. The data were presented using narrative synthesis and meta-analysis. The results were as appropriate summarized using the difference in means Results The search yielded a total of 1247 records. nine studies were included after assessment of eligibility (7 prallel RCT, and 2 cross-over randomised trials). The overall risk of bias was high; however, two studies were excluded from quantitative synthesis due missing statistical data. The pooled data demonstrate modest non-statistically significant benefit of telemonitoring (MD = −.22; 95% CI [−.48, .04], P= 0.09). However, telemonitoring using web-based system showed significantly lower HbA1C level among the intervention group at the end of follow-up (MD = −.19; 95% CI [.36, .02]; five studies pooled, p= 0.03). An effect on quality of life, and hypoglycemia could not be demonstrated. Conclusion Although the modest beneficial effect, the strength of the evidence was not robust enough to confirm effectiveness of current telemonitoring interventions on managing type one diabetes among children and adolescents. Furthermore, evidence was insufficient to determine which tool of telemonitoring have a greater impact. Further research is needed to design higher quality, larger sample size, and effective interventions for type 1 diabetes telemonitoring on the long-term.