Efficacy and safety of telemedicine for blood glucose and pregnancy outcomes in gestational diabetes mellitus: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

HUANG Na ¹ , CHEN Shuhui ¹ ,  ZHOU Yingfeng ¹ , XING Weijie ¹ , WANG Kairong ¹ , ZHONG Jie ¹ , LI li ²

1. School of Nursing, Fudan University; Shanghai Evidence-based Nursing Center, Fudan University Centre for Evidence-based Nursing; A Joanna Briggs Institute Centre of Excellence, Shanghai, 200032, P.R.China;
2. Gynecology & Obstetric Hospital, Fudan University, Shanghai, 200011, P.R.China;

Corresponding author：

ZHOU Yingfeng, Email: zyingfeng@fudan.edu.cn

Keywords：

Gestational diabetes mellitus; Telemedicine; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201902117

Video：

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Objectives To systematically review the efficacy of telemedicine on blood glucose level and pregnancy outcomes in patients with gestational diabetes mellitus.Methods The Cochrane Library, PubMed, Web of Science, CINAHL, Scopus, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on efficacy of telemedicine on blood glucose and pregnancy outcomes in patients with gestational diabetes from inception to January 1^st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by RevMan 5.3 software.Results A total of 10 RCTs involving 1 267 patients were included. The results of meta-analysis showed that there were no statistical significances in fasting blood glucose (MD=−0.34, 95%CI −1.62 to 0.93, P=0.60), HbA1c (MD=−0.22, 95%CI −0.61 to 0.17, P=0.27), gestational age at delivery (MD=0.03, 95%CI −0.13 to 0.19, P=0.72), premature rate (OR=0.52, 95%CI 0.26 to 1.01, P=0.05), caesarean delivery rate (OR=0.87, 95%CI 0.57 to 1.31, P=0.51), infant birth weight (MD=13.01, 95%CI −45.75 to 71.78, P=0.66), large for gestational age rate (OR=1.16, 95%CI 0.83 to 1.62, P=0.40), pre- eclampsia/pregnancy induced hypertension rate (OR=1.04, 95%CI 0.52 to 2.09, P=0.91), neonatal hypoglycaemia rate (OR=1.21, 95%CI 0.75 to 1.95, P=0.44) and neonatal jaundice rate (OR=1.09, 95%CI 0.59 to 2.00, P=0.78) between telemedicine management and outpatient follow-up of gestational diabetes mellitus. However, the telemedicine management group had lower 2h postprandial blood glucose (MD=−3.45, 95%CI −5.53 to −1.37, P=0.001).Conclusions The current evidence shows that telemedicine management of gestational diabetes mellitus achieves similar efficacy and safety in blood glucose level and pregnancy outcomes as outpatient follow-up. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.

Citation： HUANG Na, CHEN Shuhui, ZHOU Yingfeng, XING Weijie, WANG Kairong, ZHONG Jie, LI li. Efficacy and safety of telemedicine for blood glucose and pregnancy outcomes in gestational diabetes mellitus: a systematic review. Chinese Journal of Evidence-Based Medicine, 2019, 19(8): 960-967. doi: 10.7507/1672-2531.201902117 Copy

1.	杨慧霞, 董悦. 加强对妊娠合并糖尿病的临床研究. 中华妇产科杂志, 2003, 38(3): 129-131.
2.	International Diabetes Federation. IDF diabetes atlas (8th Edition). available at: https://www.diabetesatlas.org/across-the-globe.html.
3.	Wei Y, Yang H, Zhu W, et al. International Association of Diabetes and Pregnancy Study Group criteria is suitable for gestational diabetes mellitus diagnosis: further evidence from China. Chin Med J (Engl), 2014, 127(20): 3553-3556.
4.	American Diabetes Association. Management of diabetes in pregnancy: standards of medical care in diabetes-2018. Diabetes Care, 2018, 41(Suppl 1): S137-S143.
5.	Bellamy L, Casas JP, Hingorani AD, et al. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet, 2009, 373(9677): 1773-1779.
6.	章孟星, 周英凤, 丁焱, 等. 妊娠期糖尿病孕期管理的护理研究进展. 全科护理, 2017, 15(12): 1432-1435.
7.	谢俊祥. 远程医疗及其发展. 中国医疗器械信息, 2015, 21(3): 6-10.
8.	景丹, 马良坤. 移动医疗用于孕期健康管理的应用及研究进展. 中国妇幼健康研究, 2016, 27(5): 662-664.
9.	周英凤, 顾莺, 胡雁, 等. JBI 循证卫生保健中心关于不同类型研究的质量评价工具—干预性研究的质量评价. 护士进修杂志, 2018, 33(1): 24-26.
10.	Rasekaba TM, Furler J, Young D, et al. Using technology to support care in gestational diabetes mellitus: Quantitative outcomes of an exploratory randomised control trial of adjunct telemedicine for gestational diabetes mellitus (TeleGDM). Diabetes Res Clin Pract, 2018, 142: 276-285.
11.	Miremberg H, Ben-Ari T, Betzer T, et al. The impact of a daily smartphone-based feedback system among women with gestational diabetes on compliance, glycemic control, satisfaction, and pregnancy outcome: a randomized controlled trial. Am J Obstet Gynecol, 2018, 218(4): 453.
12.	Mackillop L, Hirst JE, Bartlett KJ, et al. Comparing the efficacy of a mobile phone-based blood glucose management system with standard clinic care in women with gestational diabetes: randomized controlled trial. JMIR Mhealth Uhealth, 2018, 6(3): e71.
13.	Given JE, Bunting BP, O'Kane MJ, et al. Tele-mum: A feasibility study for a randomized controlled trial exploring the potential for telemedicine in the diabetes care of those with gestational diabetes. Diabetes Technol Ther, 2015, 17(12): 880-888.
14.	Guo H, Zhang Y, Li P, et al. Evaluating the effects of mobile health intervention on weight management, glycemic control and pregnancy outcomes in patients with gestational diabetes mellitus. J Endocrinol Invest, 2019, 42(6): 709-714.
15.	Homko CJ, Deeb LC, Rohrbacher K, et al. Impact of a telemedicine system with automated reminders on outcomes in women with gestational diabetes mellitus. Diabetes Technol Ther, 2012, 14(7): 624-629.
16.	Pérez-Ferre N, Galindo M, Fernández MD, 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: 386941.
17.	Homko CJ, Santamore WP, Whiteman V, et al. Use of an internet-based telemedicine system to manage underserved women with gestational diabetes mellitus. Diabetes Technol Ther, 2007, 9(3): 297-306.
18.	赵正清, 钱进军, 莫永珍, 等. 移动居家护理平台对妊娠糖尿病患者血糖与生活质量的影响. 护士进修杂志, 2018, 33(6): 490-492, 496.
19.	邵颖, 何更生, 徐先明, 等. 微信平台宣教对妊娠期糖尿病患者血糖控制和妊娠结局的影响. 中华围产医学杂志, 2018, 21(10): 678-682.
20.	Bashshur RL, Shannon GW, Smith BR, et al. The empirical evidence for the telemedicine intervention in diabetes management. Telemed J E Health, 2015, 21(5): 321-354.
21.	Whitten P, Love B. Patient and provider satisfaction with the use of telemedicine: overview and rationale for cautious enthusiasm. J Postgrad Med, 2005, 51(4): 294-300.
22.	Rasekaba TM, Furler J, Blackberry I, et al. Telemedicine interventions for gestational diabetes mellitus: a systematic review and meta-analysis. Diabetes Res Clin Pract, 2015, 110(1): 1-9.
23.	Ming WK, Mackillop LH, Farmer AJ, et al. Telemedicine technologies for diabetes in pregnancy: a systematic review and meta-analysis. J Med Internet Res, 2016, 18(11): e290.
24.	Buchanan TA, Xiang AH, Page KA. Gestational diabetes mellitus: risks and management during and after pregnancy. Nat Rev Endocrinol, 2012, 8(11): 639-649.
25.	Fantinelli S, Marchetti D, Verrocchio MC, et al. Assessment of psychological dimensions in telemedicine care for gestational diabetes mellitus: a systematic review of qualitative and quantitative studies. Front Psychol, 2019, 10: 153.

1. 杨慧霞, 董悦. 加强对妊娠合并糖尿病的临床研究. 中华妇产科杂志, 2003, 38(3): 129-131.
2. International Diabetes Federation. IDF diabetes atlas (8th Edition). available at: https://www.diabetesatlas.org/across-the-globe.html.
3. Wei Y, Yang H, Zhu W, et al. International Association of Diabetes and Pregnancy Study Group criteria is suitable for gestational diabetes mellitus diagnosis: further evidence from China. Chin Med J (Engl), 2014, 127(20): 3553-3556.
4. American Diabetes Association. Management of diabetes in pregnancy: standards of medical care in diabetes-2018. Diabetes Care, 2018, 41(Suppl 1): S137-S143.
5. Bellamy L, Casas JP, Hingorani AD, et al. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet, 2009, 373(9677): 1773-1779.
6. 章孟星, 周英凤, 丁焱, 等. 妊娠期糖尿病孕期管理的护理研究进展. 全科护理, 2017, 15(12): 1432-1435.
7. 谢俊祥. 远程医疗及其发展. 中国医疗器械信息, 2015, 21(3): 6-10.
8. 景丹, 马良坤. 移动医疗用于孕期健康管理的应用及研究进展. 中国妇幼健康研究, 2016, 27(5): 662-664.
9. 周英凤, 顾莺, 胡雁, 等. JBI 循证卫生保健中心关于不同类型研究的质量评价工具—干预性研究的质量评价. 护士进修杂志, 2018, 33(1): 24-26.
10. Rasekaba TM, Furler J, Young D, et al. Using technology to support care in gestational diabetes mellitus: Quantitative outcomes of an exploratory randomised control trial of adjunct telemedicine for gestational diabetes mellitus (TeleGDM). Diabetes Res Clin Pract, 2018, 142: 276-285.
11. Miremberg H, Ben-Ari T, Betzer T, et al. The impact of a daily smartphone-based feedback system among women with gestational diabetes on compliance, glycemic control, satisfaction, and pregnancy outcome: a randomized controlled trial. Am J Obstet Gynecol, 2018, 218(4): 453.
12. Mackillop L, Hirst JE, Bartlett KJ, et al. Comparing the efficacy of a mobile phone-based blood glucose management system with standard clinic care in women with gestational diabetes: randomized controlled trial. JMIR Mhealth Uhealth, 2018, 6(3): e71.
13. Given JE, Bunting BP, O'Kane MJ, et al. Tele-mum: A feasibility study for a randomized controlled trial exploring the potential for telemedicine in the diabetes care of those with gestational diabetes. Diabetes Technol Ther, 2015, 17(12): 880-888.
14. Guo H, Zhang Y, Li P, et al. Evaluating the effects of mobile health intervention on weight management, glycemic control and pregnancy outcomes in patients with gestational diabetes mellitus. J Endocrinol Invest, 2019, 42(6): 709-714.
15. Homko CJ, Deeb LC, Rohrbacher K, et al. Impact of a telemedicine system with automated reminders on outcomes in women with gestational diabetes mellitus. Diabetes Technol Ther, 2012, 14(7): 624-629.
16. Pérez-Ferre N, Galindo M, Fernández MD, 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: 386941.
17. Homko CJ, Santamore WP, Whiteman V, et al. Use of an internet-based telemedicine system to manage underserved women with gestational diabetes mellitus. Diabetes Technol Ther, 2007, 9(3): 297-306.
18. 赵正清, 钱进军, 莫永珍, 等. 移动居家护理平台对妊娠糖尿病患者血糖与生活质量的影响. 护士进修杂志, 2018, 33(6): 490-492, 496.
19. 邵颖, 何更生, 徐先明, 等. 微信平台宣教对妊娠期糖尿病患者血糖控制和妊娠结局的影响. 中华围产医学杂志, 2018, 21(10): 678-682.
20. Bashshur RL, Shannon GW, Smith BR, et al. The empirical evidence for the telemedicine intervention in diabetes management. Telemed J E Health, 2015, 21(5): 321-354.
21. Whitten P, Love B. Patient and provider satisfaction with the use of telemedicine: overview and rationale for cautious enthusiasm. J Postgrad Med, 2005, 51(4): 294-300.
22. Rasekaba TM, Furler J, Blackberry I, et al. Telemedicine interventions for gestational diabetes mellitus: a systematic review and meta-analysis. Diabetes Res Clin Pract, 2015, 110(1): 1-9.
23. Ming WK, Mackillop LH, Farmer AJ, et al. Telemedicine technologies for diabetes in pregnancy: a systematic review and meta-analysis. J Med Internet Res, 2016, 18(11): e290.
24. Buchanan TA, Xiang AH, Page KA. Gestational diabetes mellitus: risks and management during and after pregnancy. Nat Rev Endocrinol, 2012, 8(11): 639-649.
25. Fantinelli S, Marchetti D, Verrocchio MC, et al. Assessment of psychological dimensions in telemedicine care for gestational diabetes mellitus: a systematic review of qualitative and quantitative studies. Front Psychol, 2019, 10: 153.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of telemedicine for blood glucose and pregnancy outcomes in gestational diabetes mellitus: a systematic review

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