The Impact of Telemedicine on Patient Self-Management Processes and Clinical Outcomes for Patients with Type I or II Diabetes Mellitus in the United States: A Scoping Review

Authors: Trevor M Borries1, MS; Arti Bhukhen1; Joshua Rismany1; Jessica Kilham1, MLIS; Richard Feinn1, PhD; Thomas P Meehan1,2, MD, MPH1 Quinnipiac University Frank H. Netter MD School of Medicine, North Haven, CT2 Connecticut Center for Primary Care, Farmington, CT

Introduction: Diabetes Mellitus (DM) is a chronic condition that affects 29 million people in the United States. Diabetic patients require many examinations, procedures, and clinical visits. New tools are being developed and tested to better engage patients and to improve diabetic care and clinical outcomes. Telemedicine, which is the application of telecommunication technology to treat or diagnose patients, is one such tool.

Methods: We utilized a structured scoping review protocol to conduct this research. We searched the published medical literature utilizing two databases, PubMed and CINHAL, and we included all original research articles published prior to April 15, 2016. Using a 4-step systematic approach, we identified, reviewed, extracted and summarized data from all relevant studies.

Results: We identified 594 articles in an initial search conducted with specific MESH terms. Next, we removed duplicates and applied inclusion criteria, narrowing the list to 227 articles. Then, we applied exclusion criteria which narrowed our selections to 40 relevant articles. Finally, we identified 2 additional articles via cited searching. This brought our final article total to 42. Of these, 21 involved patients with type II DM, 9 involved patients with type I DM, and 12 did not specify DM type. Of the articles that reported setting of care, 91% (21/23) were in primary care. Telemedicine impact was reported as positive in articles addressing several components of patient self-management: 83% (10/12) assessing adherence to blood glucose monitoring with half (5/10) achieving statistical significance (p<0.05); 78% (11/14) evaluating day-to-day decision-making related to self-care with 72.7% (8/11) achieving statistical significance (p<0.05); and 62% (8/13) assessing adherence with medications with 37.5% (3/8) achieving statistical significance (p<0.05). The most commonly reported clinical outcome was an intermediate measure, i.e. HbA1c level. We found that 69% (18/26) of the articles evaluating this outcome reported telemedicine having a positive impact with 67% (12/18) statistically significant (p < 0.05). No study evaluated impact on long term clinical outcomes such as blindness, amputation, cardiovascular events, development of chronic kidney disease, or mortality.

Conclusion: This scoping review provides important information about studies evaluating the impact of telemedicine on patient self-management and on clinical outcomes in patients with DM. Published research suggests that telemedicine is having a positive impact on self-management processes and on HbA1c levels. However, future evaluative reviews are necessary to confirm and to quantitate the impact of telemedicine on self-management processes, and primary studies are necessary to evaluate its impact on long term clinical outcomes.

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