Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Mar 15:13:848695.
doi: 10.3389/fendo.2022.848695. eCollection 2022.

Effectiveness of Remotely Delivered Interventions to Simultaneously Optimize Management of Hypertension, Hyperglycemia and Dyslipidemia in People With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Malindu E Fernando  1   2   3 , Leonard Seng  1 , Aaron Drovandi  1   2 , Benjamin J Crowley  1 , Jonathan Golledge  1   2   4   5
Affiliations
Meta-Analysis

Effectiveness of Remotely Delivered Interventions to Simultaneously Optimize Management of Hypertension, Hyperglycemia and Dyslipidemia in People With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Malindu E Fernando et al. Front Endocrinol (Lausanne). .

Erratum in

Abstract

Background: Remotely delivered interventions may be more efficient in controlling multiple risk factors in people with diabetes.

Purpose: To pool evidence from randomized controlled trials testing remote management interventions to simultaneously control blood pressure, blood glucose and lipids.

Data sources: PubMed/Medline, EMBASE, CINAHL and the Cochrane library were systematically searched for randomized controlled trials (RCTs) until 20th June 2021.

Study selection: Included RCTs were those that reported participant data on blood pressure, blood glucose, and lipid outcomes in response to a remotely delivered intervention.

Data extraction: Three authors extracted data using a predefined template. Primary outcomes were glycated hemoglobin (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), systolic and diastolic blood pressure (SBP & DBP). Risk of bias was assessed using the Cochrane collaboration RoB-2 tool. Meta-analyses are reported as standardized mean difference (SMD) with 95% confidence intervals (95%CI).

Data synthesis: Twenty-seven RCTs reporting on 9100 participants (4581 intervention and 4519 usual care) were included. Components of the remote management interventions tested were identified as patient education, risk factor monitoring, coaching on monitoring, consultations, and pharmacological management. Comparator groups were typically face-to-face usual patient care. Remote management significantly reduced HbA1c (SMD -0.25, 95%CI -0.33 to -0.17, p<0.001), TC (SMD -0.17, 95%CI -0.29 to -0.04, p<0.0001), LDL-c (SMD -0.11, 95%CI -0.19 to -0.03, p=0.006), SBP (SMD -0.11, 95%CI -0.18 to -0.04, p=0.001) and DBP (SMD -0.09, 95%CI -0.16 to -0.02, p=0.02), with low to moderate heterogeneity (I²= 0 to 75). Twelve trials had high risk of bias, 12 had some risk and three were at low risk of bias.

Limitations: Heterogeneity and potential publication bias may limit applicability of findings.

Conclusions: Remote management significantly improves control of modifiable risk factors.

Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258433], identifier PROSPERO (CRD42021258433).

Keywords: blood pressure; cholesterol; lipids; systematic review; telehealth.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the search results and number of eligible articles included.
Figure 2
Figure 2
(A) Forest plot showing the effect of remote risk factor management on HbA1c, (B) Forest plot showing the effect of remote management on total cholesterol, (C) Forest plot showing the effect of remote risk factor management on LDL-cholesterol.
Figure 3
Figure 3
(A) Forest plot showing the effect of remote management on systolic blood pressure, (B) Forest plot showing the effect of remote risk factor management on diastolic blood pressure.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Alicic RZ, Rooney MT, Tuttle KR. Diabetic Kidney Disease: Challenges, Progress, and Possibilities. Clin J Am Soc Nephrol (2017) 12:2032–45. doi: 10.2215/CJN.11491116 - DOI - PMC - PubMed
    1. Singh N, Armstrong DG, Lipsky BA. Preventing Foot Ulcers in Patients With Diabetes. JAMA (2005) 293:217–28. doi: 10.1001/jama.293.2.217 - DOI - PubMed
    1. Bonaca MP, Nault P, Giugliano RP, Keech AC, Pineda AL, Kanevsky E, et al. . Low-Density Lipoprotein Cholesterol Lowering With Evolocumab and Outcomes in Patients With Peripheral Artery Disease: Insights From the FOURIER Trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk). Circulation (2018) 137:338–50. doi: 10.1161/CIRCULATIONAHA.117.032235 - DOI - PubMed
    1. Heart Protection Study Collaborative Group . Randomized Trial of the Effects of Cholesterol-Lowering With Simvastatin on Peripheral Vascular and Other Major Vascular Outcomes in 20,536 People With Peripheral Arterial Disease and Other High-Risk Conditions. J Vasc Surg (2007) 45:645–54. doi: 10.1016/j.jvs.2006.12.054 - DOI - PubMed
    1. Anand SS, Caron F, Eikelboom JW, Bosch J, Dyal L, Aboyans V, et al. . Major Adverse Limb Events and Mortality in Patients With Peripheral Artery Disease: The COMPASS Trial. J Am Coll Cardiol (2018) 71:2306–15. doi: 10.1016/j.jacc.2018.03.008 - DOI - PubMed

MeSH terms