Assessing the Impact of Telemonitoring-Facilitated Lifestyle Modifications on Diabetes Outcomes: A Systematic Review and Meta-Analysis

Introduction: Lifestyle modification to promote regular physical activity and healthy eating is a key element of diabetes management. We aimed at evaluating randomized controlled trials that assess the impact of telemonitoring on diabetes outcomes with the inclusion of lifestyle change components. Methods: A systematic review search in relevant databases was conducted for studies published from January 2000 to October 2018. The search was restricted to studies published in English and included adult patients with type 2 diabetes. Study selection criteria included telehealth programs with remote monitoring of physiological data and feedback features. We further performed meta-analyses to summarize the pooled effect size (presented by the mean difference [MD]) of hemoglobin A1c (HbA1c) and weight loss outcomes. Results: Seventeen studies were included in the data synthesis (15 of them were included in the meta-analysis), with the sample size ranging from 18 to 484 and the study period ranging from 3 to 12 months. Telemonitoring achieved a significant but modest reduction in HbA1c (MD = -0.30%; 95% confidence interval [CI]: -0.31% to -0.29%) and weight loss (kg) outcomes (MD = -0.62; 95% CI: -0.78 to -0.45) compared with usual care. In the subgroup analyses, it was suggested that telemonitoring with automatic mobile transmission or with real-time feedback modality led to a greater improvement in HbA1c outcomes (MD = -0.61% and -0.77%, respectively) when compared with telemonitoring without these features. Conclusions: Telemonitoring has a great potential to further enhance diabetes management with the inclusion of a system approach for supporting patients' lifestyle changes. Features such as automatic mobile transmission and real-time feedback show promise to boost effectiveness of telemonitoring in diabetes management in the future.