Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes
- PMID: 37254718
- PMCID: PMC10233616
- DOI: 10.1002/14651858.CD014513
Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes
Abstract
Background: There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision-makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations.
Objectives: To update existing systematic reviews of diabetes QI programmes and apply novel meta-analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care.
Search methods: We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top-up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section.
Selection criteria: We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system- or provider-targeted QI strategy alone or in combination with a patient-targeted strategy. - System-targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). - Provider-targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). - Patient-targeted: patient education (PE); promotion of self-management (PSM); patient reminders (PR). Patient-targeted QI strategies needed to occur with a minimum of one provider or system-targeted strategy.
Data collection and analysis: We dual-screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta-regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outcomes. To explore this further, we extended the main additive model for continuous outcomes (HbA1c, SBP and LDL-C) to include an interaction term between each strategy and average baseline risk for each study (baseline thresholds were based on a data-driven approach; we used the median of all baseline values reported in the trials). Based on model diagnostics, the baseline interaction models for HbA1c, SBP and LDL-C performed better than the main model and are therefore presented as the primary analyses for these outcomes. Based on the model results, we qualitatively ordered each QI strategy within three tiers (Top, Middle, Bottom) based on its magnitude of effect relative to the other QI strategies, where 'Top' indicates that the QI strategy was likely one of the most effective strategies for that specific outcome. Secondary analyses explored the sensitivity of results to choices in model specification and priors. Additional information about the methods and results of the review are available as Appendices in an online repository. This review will be maintained as a living systematic review; we will update our syntheses as more data become available.
Main results: We identified 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412,161 participants. Of the included studies, 66% involved people living with type 2 diabetes only. Participants were 50% female and the median age of participants was 58.4 years. The mean duration of follow-up was 12.5 months. HbA1c was the commonest reported outcome; screening outcomes and outcomes related to cardiovascular medications, smoking and harms were reported infrequently. The most frequently evaluated QI strategies across all study arms were PE, PSM and CM, while the least frequently evaluated QI strategies included AF, FI and CQI. Our confidence in the evidence is limited due to a lack of information on how studies were conducted. Four QI strategies (CM, TC, PE, PSM) were consistently identified as 'Top' across the majority of outcomes. All QI strategies were ranked as 'Top' for at least one key outcome. The majority of effects of individual QI strategies were modest, but when used in combination could result in meaningful population-level improvements across the majority of outcomes. The median number of QI strategies in multicomponent QI programmes was three. Combinations of the three most effective QI strategies were estimated to lead to the below effects: - PR + PSM + CE: decrease in HbA1c by 0.41% (credibility interval (CrI) -0.61 to -0.22) when baseline HbA1c < 8.3%; - CM + PE + EPR: decrease in HbA1c by 0.62% (CrI -0.84 to -0.39) when baseline HbA1c > 8.3%; - PE + TC + PSM: reduction in SBP by 2.14 mmHg (CrI -3.80 to -0.52) when baseline SBP < 136 mmHg; - CM + TC + PSM: reduction in SBP by 4.39 mmHg (CrI -6.20 to -2.56) when baseline SBP > 136 mmHg; - TC + PE + CM: LDL-C lowering of 5.73 mg/dL (CrI -7.93 to -3.61) when baseline LDL < 107 mg/dL; - TC + CM + CR: LDL-C lowering by 5.52 mg/dL (CrI -9.24 to -1.89) when baseline LDL > 107 mg/dL. Assuming a baseline screening rate of 50%, the three most effective QI strategies were estimated to lead to an absolute improvement of 33% in retinopathy screening (PE + PR + TC) and 38% absolute increase in foot screening (PE + TC + Other).
Authors' conclusions: There is a significant body of evidence about QI programmes to improve the management of diabetes. Multicomponent QI programmes for diabetes care (comprised of effective QI strategies) may achieve meaningful population-level improvements across the majority of outcomes. For health system decision-makers, the evidence summarised in this review can be used to identify strategies to include in QI programmes. For researchers, this synthesis identifies higher-priority QI strategies to examine in further research regarding how to optimise their evaluation and effects. We will maintain this as a living systematic review.
Copyright © 2023 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.
Conflict of interest statement
Mostafa Alabousi: none known.
Alun Edwards: none known.
Jeremy Grimshaw: Canada Research Chairs (Grant/Contract); Canadian Institutes of Health Research (Grant/Contract); Co‐ordinating Editor of the Cochrane Effective Practice and Organisation of Care group (1997‐2015) and currently an Emeritus Editor; involved with Diabetes UK, Northern and Yorkshire Regional NHS R&D Office, CIHR ‐ Knowledge Translation Improved Clinical Effectiveness Behavioral Research Group (KT‐ICEBeRG), see Eccles 2007, Ivers 2013, Presseau 2018.
Michael Hillmer: Ontario Ministry of Health and Long‐Term Care (Employment).
Noah Ivers: Merck (Consultant); Novo Nordisk (Consultant); works as a health professional at Women’s College Hospital, Toronto, Ontario, Canada; affiliated to Diabetes Canada; editorial role with Cochrane EPOC; involved with CIHR as principal investigator.
Sathya Karunananthan: none known.
Kristin Konnyu: none known.
John Lavis: none known.
Johanie Lepine: none known.
Stefanie Linklater: none known.
Braden Manns: no relevant interests; works as a physician who sees patients with diabetes and kidney disease (salaried physician).
David Moher: none known.
Sameh Mortazhejri: none known.
Samir Nazarali: none known.
P. Alison Paprica: none known.
Timothy Ramsay: none known.
Paul MacDaragh Ryan: no relevant interests; Paediatrics Resident, University of Toronto/The Hospital for Sick Children.
Peter Sargious: Alberta Health Services (Senior Medical Director); published op‐ep in
Kaveh Shojania: none known.
Sharon Straus: no relevant interests; Physician‐in‐Chief, Department of Medicine, St. Michael's Hospital, Unity Health Toronto 30 Bond Street Toronto, Ontario, Canada M5B 1W8.
Katrina Sullivan: none known.
Marcell Tonelli: AstraZeneca (lectures); Section Editor, Uptodate (Wolters Klewer Health, Inc.); works as a nephrologist.
Andrea Tricco: none known.
Thomas Trikalinos: Pacira Pharmaceuticals Incorporated (Expert Witness).
Brigitte Vachon: none known.
Sharlini Yogasingam: none known.
Catherine Yu: no relevant interests; Endocrinologist, St. Michael's Hospital.
Michael Zahradnik: none known.
Figures
References
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Cohen 2019 {published data only}
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- Cohen L B, Taveira T H, Wu W C, Pirraglia P A. Pharmacist-led telehealth disease management for patients with diabetes and depression. Journal of Telemedicine & Telecare 2019;26(5):294-302. - PubMed
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- Crasto W, Jarvis J, Khunti K, Skinner T C, Gray L J, Brela J, et al. Multifactorial intervention in individuals with type 2 diabetes and microalbuminuria: the Microalbuminuria Education and Medication Optimisation (MEMO) study. Diabetes Research and Clinical Practice 2011;93(3):328-36. - PubMed
Crowley 2013 {published data only}
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- Crowley M J, Powers B J, Olsen M K, Grubber J M, Koropchak C, Rose C M, et al. The Cholesterol, Hypertension, And Glucose Education (CHANGE) study: results from a randomized controlled trial in African Americans with diabetes. American Heart Journal 2013;166(1):179-86. - PubMed
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- Crowley M J, Edelman D, McAndrew A T, Kistler S, Danus S, Webb J A, et al. Practical telemedicine for veterans with persistently poor diabetes control: a randomized pilot trial. Telemedicine and e-Health 2016;22(5):376-84. - PubMed
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- Cummings D M, Lutes L D, Littlewood K, Solar C, Carraway M, Kirian K, et al. Randomized trial of a tailored cognitive behavioral intervention in type 2 diabetes with comorbid depressive and/or regimen-related distress symptoms: 12-month outcomes from COMRADE. Diabetes Care 2019;42(5):841-8. - PubMed
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- D'Souza M S, Karkada S N, Labrague L J, Ali Ammouri A A. How do multi-modality strategies affect outcomes in T2D using a randomized control trial? Clinical Epidemiology and Global Health 2019;7(4):578-85.
Dai 2018 {published data only}
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- Dai Limin, Huo Xiaorong, Mo Yongzhen. Application and effect evaluation on Internet + home care mobile APP in patients with type 2 diabetes in young and middle-age. Chinese Nursing Research 2018;32(20):3207-12.
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- Dale J, Caramlau I, Sturt J, Friede T, Walker R. Telephone peer-delivered intervention for diabetes motivation and support: the telecare exploratory RCT. Patient Education and Counseling 2009;75(1):91-8. - PubMed
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- Wit M, Rondags Smpa, Tulder M W, Snoek F J, Bosmans J E. Cost-effectiveness of the psycho-educational blended (group and online) intervention HypoAware compared with usual care for people with type 1 and insulin-treated type 2 diabetes with problematic hypoglycaemia: analyses of a cluster-randomized controlled trial. Diabetic Medicine 2018;35(2):214-22. - PubMed
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Dijkstra 2005 {published data only}
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Edelman 2015 {published data only}
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Farsaei 2011 {published data only}
Fernandes 2018 {published data only}
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- Hayashino Y, Suzuki H, Yamazaki K, Goto A, Izumi K, Noda M. A cluster randomized trial on the effect of a multifaceted intervention improved the technical quality of diabetes care by primary care physicians: The Japan Diabetes Outcome Intervention Trial-2 (J-DOIT2). Diabetic Medicine 2016;33(5):599-608. - PMC - PubMed
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- Heisler M, Hofer T P, Schmittdiel J A, Selby J V, Klamerus M L, Bosworth H B, et al. Improving blood pressure control through a clinical pharmacist outreach program in patients with diabetes mellitus in 2 high-performing health systems: the adherence and intensification of medications cluster randomized, controlled pragmatic trial. Circulation 2012;125(23):2863-72. - PMC - PubMed
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- Hsu W C, Lau K H, Huang R, Ghiloni S, Le H, Gilroy S, Abrahamson M, Moore J. Utilization of a cloud-based diabetes management program for insulin initiation and titration enables collaborative decision making between healthcare providers and patients. Diabetes Technology & Therapeutics 2016;18:59. - PMC - PubMed
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Imai 2008 {published data only}
Ishani 2011 {published data only}
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- Ismail M, Teng C L, Omar M, Ho B K, Kusiar Z, Hasim R. Usage of glucometer is associated with improved glycaemic control in type 2 diabetes mellitus patients in Malaysian public primary care clinics: an open-label, randomised controlled trial. Singapore Medical Journal 2013;54(7):391-5. - PubMed
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O'Connor 2009b {published data only}
O'Connor 2011 {published data only}
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Perez‐Escamilla 2015 {published data only}
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Tang 2013 {published data only}
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- Tang P C, Overhage J M, Chan A S, Brown N L, Aghighi B, Entwistle M P, et al. Online disease management of diabetes: engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial. Journal of the American Medical Informatics Association: JAMIA 2013;20(3):526-34. - PMC - PubMed
Tang 2015 {published data only}
Taveira 2010 {published data only}
-
- Taveira T H, Friedmann P D, Cohen L B, Dooley A G, Khatana S A, Pirraglia P A, et al. Pharmacist-led group medical appointment model in type 2 diabetes. Diabetes Educator 2010;36(1):109-17. - PubMed
Taveira 2011 {published data only}
-
- Taveira T H, Dooley A G, Cohen L B, Khatana S A, Wu W C. Pharmacist-led group medical appointments for the management of type 2 diabetes with comorbid depression in older adults. Annals of Pharmacotherapy 2011;45(11):1346-55. - PubMed
Taveira 2014 {published data only}
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- Taveira T H, Wu W C. Interventions to maintain cardiac risk control after discharge from a cardiovascular risk reduction clinic: a randomized controlled trial. Diabetes Research and Clinical Practice 2014;105(3):327-35. - PubMed
Taylor 2003 {published data only}
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- Taylor C B, Miller N H, Reilly K R, Greenwald G, Cunning D, Deeter A, et al. Evaluation of a nurse-care management system to improve outcomes in patients with complicated diabetes. Diabetes Care 2003;26(4):1058-63. - PubMed
Taylor 2005 {published data only}
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- Taylor K I, Oberle K M, Crutcher R A, Norton P G. Promoting health in type 2 diabetes: nurse-physician collaboration in primary care. Biological Research for Nursing 2005;6(3):207-15. - PubMed
Thankappan 2013 {published data only}
Thomas 2007 {published data only}
Thompson 1999 {published data only}
Tildesley 2010 {published data only}
Tildesley 2011 {published data only}
-
- Tildesley H D, Mazanderani A B, Chan J H M, Ross S A. Efficacy of A1C reduction using internet intervention in patients with type 2 diabetes treated with insulin. Canadian Journal of Diabetes 2011;35(3):250-3.
Tjam 2006 {published data only}
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- Tjam E Y, Sherifali D, Steinacher N, Hett S. Physiological outcomes of an internet disease management program vs. in-person counselling: a randomized, controlled trial. Canadian Journal of Diabetes 2006;30(4):397-405.
Tobe 2006 {published data only}
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- Tobe S W, Pylypchuk G, Wentworth J, Kiss A, Szalai J P, Perkins N, et al. Effect of nurse-directed hypertension treatment among First Nations people with existing hypertension and diabetes mellitus: the Diabetes Risk Evaluation and Microalbuminuria (DREAM 3) randomized controlled trial. CMAJ 2006;174(9):1267-71. - PMC - PubMed
Tourkmani 2018 {published data only}
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- Tourkmani A M, Abdelhay O, Alkhashan H I, Alaboud A F, Bakhit A, Elsaid T, et al. Impact of an integrated care program on glycemic control and cardiovascular risk factors in patients with type 2 diabetes in Saudi Arabia: an interventional parallel-group controlled study. BMC Family Practice 2018;19(1):1. - PMC - PubMed
Trento 2008 {published data only}
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- Trento M, Basile M, Borgo E, Grassi G, Scuntero P, Trinetta A, et al. A randomised controlled clinical trial of nurse-, dietitian- and pedagogist-led group care for the management of Type 2 diabetes. Journal of Endocrinological Investigation 2008;31(11):1038-42. - PubMed
Tsuyuki 2016 {published data only}
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- Al Hamarneh YN, Hemmelgarn BR, Hassan I, Jones CA, Tsuyuki RT. The effectiveness of pharmacist interventions on cardiovascular risk in adult patients with type 2 diabetes: the multicentre randomized controlled R(x)EACHTrial. Canadian Journal of Diabetes 2017;41(6):580-6. - PubMed
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- Tsuyuki R T, Al Hamarneh Y N, Jones C A, Hemmelgarn B R. The effectiveness of pharmacist interventions on cardiovascular risk: the multicenter randomized controlled RxEACH Trial. Journal of the American College of Cardiology 2016;67(24):2846-54. - PubMed
Tu 1993 {published data only}
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- Tu K S, McDaniel G, Gay J T. Diabetes self-care knowledge, behaviors, and metabolic control of older adults--the effect of a posteducational follow-up program. Diabetes Education 1993;19:25-30. - PubMed
Tutino 2017 {published data only}
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- Tutino G E, Yang W Y, Li X, Li W H, Zhang Y Y, Guo X H, et al, China Jade Study Group. A multicentre demonstration project to evaluate the effectiveness and acceptability of the web-based Joint Asia Diabetes Evaluation (JADE) programme with or without nurse support in Chinese patients with type 2 diabetes. Diabetic Medicine 2017;34(3):440-50. - PMC - PubMed
Vadstrup 2011 {published data only}
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- Vadstrup E S, Frolich A, Perrild H, Borg E, Roder M. Effect of a group-based rehabilitation programme on glycaemic control and cardiovascular risk factors in type 2 diabetes patients: the Copenhagen Type 2 Diabetes Rehabilitation Project. Patient Education and Counseling 2011;84(2):185-90. - PubMed
van Bruggen 2008 {published data only}
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- Bruggen R, Gorter K J, Stolk R P, Verhoeven R P, Rutten G E. Implementation of locally adapted guidelines on type 2 diabetes. Family Practice 2008;25(6):430-7. - PubMed
Van Dijk‐de Vries 2015 {published data only}
Van Dyck 2013 {published data only}
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- Van Dyck D, De Greef K, Deforche B, Ruige J, Bouckaert J, Tudor-Locke C E, et al. The relationship between changes in steps/day and health outcomes after a pedometer-based physical activity intervention with telephone support in type 2 diabetes patients. Health Education Research 2013;28(3):539-45. - PubMed
VanEpps 2018 {published data only}
Van Veldhuizen‐Scott 1995 {published data only}
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- Van Veldhuizen-Scott M K, Widmer L B, Stacey S A, Popovich N G. Developing and implementing a pharmaceutical care model in an ambulatory care setting for patients with diabetes. Diabetes Education 1995;21(2):117-23. - PubMed
Varney 2014 {published data only}
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- Varney J E, Weiland T J, Inder W J, Jelinek G A. Effect of hospital-based telephone coaching on glycaemic control and adherence to management guidelines in type 2 diabetes, a randomised controlled trial. Internal Medicine Journal 2014;44:890. - PubMed
Vaughan 2017 {published data only}
Vidal‐Pardo 2013 {published data only}
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- Vidal-Pardo J I, Perez-Castro T R, Lopez-Alvarez X L, Santiago-Perez M I, Garcia-Soidan F J, Muniz J. Effect of an educational intervention in primary care physicians on the compliance of indicators of good clinical practice in the treatment of type 2 diabetes mellitus [OBTEDIGA project]. International Journal of Clinical Practice 2013;67(8):750-8. - PubMed
Vinicor 1987 {published data only}
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- Mazzuca S A, Moorman N H, Wheeler M L, Norton J A, Fineberg N S, Vinicor F, et al. The diabetes education study: a controlled trial of the effects of diabetes patient education. Diabetes Care 1986;9(1):1-10. - PubMed
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- Vinicor F, Cohen S J, Mazzuca S A, Moorman N, Wheeler M, Kuebler T, et al. DIABEDS: a randomized trial of the effects of physician and/or patient education on diabetes patient outcomes. Journal of Chronic Diseases 1987;40(4):345-56. - PubMed
Volpp 2015 {published data only}
Wagner 2001 {published data only}
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- Wagner E H, Grothaus L C, Sandhu N, Galvin M S, McGregor M, Artz K, et al. Chronic care clinics for diabetes in primary care: a system-wide randomized trial. Diabetes Care 2001;24(4):695-700. - PubMed
Wakefield 2011 {published data only}
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- Wakefield B J, Holman J E, Ray A, Scherubel M, Adams M R, Hillis S L, et al. Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial. Telemedicine Journal and E-health 2011;17(4):254-61. - PubMed
Wakefield 2014 {published data only}
Waki 2014 {published data only}
Wallymahmed 2011 {published data only}
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- Wallymahmed M E, Morgan C, Gill G V, Macfarlane I A. Nurse-led cardiovascular risk factor intervention leads to improvements in cardiovascular risk targets and glycaemic control in people with Type 1 diabetes when compared with routine diabetes clinic attendance. Diabetic Medicine 2011;28(3):373-9. - PubMed
Wang 2017 {published data only}
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- Wang G, Zhang Z, Feng Y, Sun L, Xiao X, Wang G, et al. Telemedicine in the management of type 2 diabetes mellitus. American Journal of the Medical Sciences 2017;353(1):1-5. - PubMed
Ward 1996 {published data only}
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- Ward A, Kamien M, Mansfield F, Fatovich B. Educational feedback in the management of type 2 diabetes in general practice. Education for General Practice 1996;7:142-50.
Warren 2018 {published data only}
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- Warren R, Carlisle K, Mihala G, Scuffham P A. Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: a randomised controlled trial. Journal of Telemedicine & Telecare 2018;24(9):586-95. - PubMed
Wayne 2015 {published data only}
Webb 2017 {published data only}
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- Webb E M, Rheeder P. A cluster-randomized trial to estimate the effect of mobile screening and treatment feedback on HbA1c and diabetes-related complications in Tshwane primary health care clinics, South Africa. Primary Care Diabetes 2017;11(6):546-54. - PubMed
Wei 2017 {published data only}
Weinberger 1995 {published data only}
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- Weinberger M, Kirkman M S, Samsa G P, Shortliffe E A, Landsman P B, Cowper P A, et al. A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus: impact on glycemic control and health-related quality of life. Journal of General Internal Medicine 1995;10(2):59-66. - PubMed
Weiss 2015 {published data only}
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- Weiss D M, Casten R J, Leiby B E, Hark L A, Murchison A P, Johnson D, et al. Effect of behavioral intervention on dilated fundus examination rates in older African American individuals with diabetes mellitus: a randomized clinical trial. JAMA Ophthalmology 2015;133(9):1005-12. - PubMed
Welch 2011a {published data only}
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- Welch G, Allen N A, Zagarins S E, Stamp K D, Bursell S E, Kedziora R J. Comprehensive diabetes management program for poorly controlled Hispanic type 2 patients at a community health center. Diabetes Educator 2011;37(5):680-8. - PubMed
Welch 2011b {published data only}
Welch 2015 {published data only}
White 2017 {published data only}
-
- White M, O'Connell M A, Cameron F J. Clinic attendance and disengagement of young adults with type 1 diabetes after transition of care from paediatric to adult services (TrACeD): a randomised, open-label, controlled trial. Lancet Child & Adolescent Health 2017;1(4):274-83. - PubMed
Whitlock 2000 {published data only}
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- Whitlock W L, Brown A, Moore K, Pavliscsak H, Dingbaum A, Lacefield D, et al. Telemedicine improved diabetic management. Military Medicine 2000;165(8):579. - PubMed
Wild 2016 {published data only}
Williams 2012 {published data only}
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- Williams A, Manias E, Walker R, Gorelik A. A multifactorial intervention to improve blood pressure control in co-existing diabetes and kidney disease: a feasibility randomized controlled trial. Journal of Advanced Nursing 2012;68(11):2515-25. - PubMed
Wilson 2014 {published data only}
Wishah 2015 {published data only}
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- Wishah R A, Al-Khawaldeh O A, Albsoul A M. Impact of pharmaceutical care interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes: Randomized controlled trial. Diabetology & Metabolic Syndrome 2015;9(4):271-6. - PubMed
Wisse 2010 {published data only}
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- Wisse W, Boer Rookhuizen M, Kruif M D, Rossum J, Jordans I, ten Cate H, et al. Prescription of physical activity is not sufficient to change sedentary behavior and improve glycemic control in type 2 diabetes patients. Diabetes Research and Clinical Practice 2010;88(2):e10-3. - PubMed
Wojcicki 2001 {published data only}
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- Wojcicki J M, Ladyzynski P, Krzymien J, Jozwicka E, Blachowicz J, Janczewska E, et al. What we can really expect from telemedicine in intensive diabetes treatment: results from 3-year study on type 1 pregnant diabetic women. Diabetes Technology & Therapeutics 2001;3(4):581-9. - PubMed
Wolf 2013 {published data only}
Wu 2018 {published data only}
Yang 2013 {published data only}
Yaron 2019 {published data only}
-
- Yaron M, Sher B, Sorek D, Shomer M, Levek N, Schiller T, et al. A randomized controlled trial comparing a telemedicine therapeutic intervention with routine care in adults with type 1 diabetes mellitus treated by insulin pumps. Acta Diabetologica 2019;56(6):667-73. - PubMed
Yin 2017 {published data only}
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- Yin J, Luk A, Wong R, Chung H, Kong A, Ozaki R, et al. Regular mailing of personalized feedback reports improved glycemic control in diabetes - a randomized controlled trial. Journal of Diabetes 2017;9(5):536-8. - PubMed
Yoo 2009 {published data only}
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- Yoo H J, Park M S, Kim T N, Yang S J, Cho G J, Hwang T G, et al. A ubiquitous chronic disease care system using cellular phones and the internet. Diabetic Medicine 2009;26(6):628-35. - PubMed
Yoon 2008 {published data only}
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- Yoon K H, Kim H S. A short message service by cellular phone in type 2 diabetic patients for 12 months. Diabetes Research and Clinical Practice 2008;79(2):256-61. - PubMed
Yu 2019 {published data only}
Yuan 2016 {published data only}
-
- Yuan X, Wang F, Fish A F, Xue C, Chen T, Liu C, Lou Q. Effect of case management on glycemic control and behavioral outcomes for Chinese people with type 2 diabetes: a 2-year study. Patient Education and Counseling 2016;99(8):1382-8. - PubMed
Zapotoczky 2001 {published data only}
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- Zapotoczky H, Semlitsch B, Herzog G, Bahadori B, Siebenhofer A, Pieber T R, et al. A controlled study of weight reduction in type 2 diabetics treated by two reinforcers. International Journal of Behavioral Medicine 2001;8(1):42-9.
Zgibor 2018 {published data only}
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- Zgibor JC, Maloney MA, Malmi M Jr, Fabio A, Kuo S, Solano FX, et al. Effectiveness of certified diabetes educators following pre-approved protocols to redesign diabetes care delivery in primary care: Results of the REMEDIES 4D trial. Contemporary Clinical Trials 2018;64:201-9. - PubMed
Zhou 2014 {published data only}
Zhou 2016 {published data only}
-
- Zhou W, Chen M, Yuan J, Sun Y. Welltang - a smart phone-based diabetes management application - improves blood glucose control in Chinese people with diabetes. Diabetes Research and Clinical Practice 2016;116:105. - PubMed
Zolfaghari 2012 {published data only}
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- Zolfaghari M, Mousavifar S A, Pedram S, Haghani H. The impact of nurse short message services and telephone follow-ups on diabetic adherence: which one is more effective? Journal of Clinical Nursing 2012;21(13-4):1922-31. - PubMed
References to studies excluded from this review
Abkenar 2016 {published data only}
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- Abkenar MZ, Ghofranipour F, Maghrebi HF, Kashi Z, Shokravi FA. The effect of Islamic care method on nutritional self-care, anthropometric indices and blood pressure in diabetic patients. Journal of Mazandaran University of Medical Sciences 2016;26:36-53.
Agewall 2001 {published data only}
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- Agewall S, Fagerberg B, Berglund G, Schmidt C, Wendelhag I, Wikstrand J, Risk Factor Intervention Study Group, Sweden. Multiple risk intervention trial in high risk hypertensive men: comparison of ultrasound intima-media thickness and clinical outcome during 6 years of follow-up. Journal of Internal Medicine 2001;249(4):305-14. - PubMed
Aguila 2018 {published data only}
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- Aguila IP, Velázquez-López L, Goycochea-Robles MAV, Angulo-Angulo F, Peña JE. Multimedia education to support management of type 2 diabetes patients. A quasi-experimental study [La educación multimedia como apoyo en el manejo de pacientes con diabetes tipo 2. Estudio cuasi experimental]. Cirugía y Cirujanos 2018;86(5):404-11. - PubMed
Alfadda 2011 {published data only}
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- Alfadda AA, Bin-Abdulrahman KA, Saad HA, Mendoza CDO, Angkaya-Bagayawa FF, Yale JF. Effect of an intervention to improve the management of patients with diabetes in primary care practice. Saudi Medical Journal 2011;32(1):36-40. - PubMed
Basch 1999 {published data only}
Bhattacharyya 2010 {published data only}
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- Bhattacharya O, Harris S, Zwarenstein M, Barnsley J. Controlled trial of an intervention to improve cholesterol management in diabetes patients in remote Aboriginal communities. International Journal of Circumpolar Health 2010;69(4):333-43. - PubMed
Butt 2016 {published data only}
Campbell 1996 {published data only}
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- Campbell EM, Redman S, Moffitt PS, Sanson-Fisher RW. The relative effectiveness of educational and behavioral instruction programs for patients with NIDDM: a randomized trial. Diabetes Educator 1996;22(4):379-86. - PubMed
Chen 2008 {published data only}
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- Chen HS, Wu TE, Jap TS, Chen RL, Lin HD. Effects of health education on glycemic control during holiday time in patients with type 2 diabetes mellitus. American Journal of Managed Care 2008;14(1):45-51. - PubMed
Chen 2015 {published data only}
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- Chen MF, Wang RH, Lin KC, Hsu HY, Chen SW. Efficacy of an empowerment program for Taiwanese patients with type 2 diabetes: A randomized controlled trial. Applied Nursing Research 2015;28(4):366-73. - PubMed
Chow 2016 {published data only}
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- Chow EP, Hassali MA, Saleem F, Aljadhey H. Effects of pharmacist-led patient education on diabetes-related knowledge and medication adherence: a home-based study. Health Education Journal 2016;75(4):421-33.
Cortés‐Sanabria 2008 {published data only}
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- Cortés-Sanabria L, Cabrera-Pivaral CE, Cueto-Manzano AM, Rojas-Campos E, Barragán G, Hernández-Anaya M, et al. Improving care of patients with diabetes and CKD: a pilot study for a cluster-randomized trial. American Journal of Kidney Diseases 2008;51(5):777-88. - PubMed
Cortez 2017 {published data only}
Fisher 2011 {published data only}
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- Fisher L, Polonsky W, Parkin CG, Jelsovsky Z, Amstutz L, Wagner RS. The impact of blood glucose monitoring on depression and distress in insulin-naïve patients with type 2 diabetes. Current Medical Research and Opinion 2011;27(Suppl 3):39-46. - PubMed
Gaillard 2015 {published data only}
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- Gaillard T, Amponsah G, Osei K. Patient-centered community diabetes education program improves glycemic control in African-American patients with poorly controlled type 2 diabetes: importance of point of care metabolic measurements. Journal of National Black Nurses' Association 2015;26(1):50-7. - PubMed
Hajbaghery 2012 {published data only}
-
- Hajbaghery MA, Alinaghipoor T. The effects of lecture and multimodal methods of teaching on healing rate of diabetic foot ulcer and patients' compliance with care recommendations. Iran Journal of Nursing 2012;25:1-11.
Kim 2006 {published data only}
-
- Kim HS, Park HJ. Effects of a nurse short-message service via cellular phones for people with diabetes. Journal of Korean Academic Society of Nursing Education 2006;13(2):235-41.
Kushner 2009 {published data only}
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- Kushner RF, Sujak M. Prevention of weight gain in adult patients with type 2 diabetes treated with pioglitazone. Obesity (Silver Spring) 2011;17(5):1017-22. - PubMed
Litzelman 1993 {published data only}
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- Litzelman DK, Slemenda CW, Langefeld CD, Hays LM, Welch MA, Bild DE, et al. Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial. Annals of Internal Medicine 1993;119(1):36-41. - PubMed
Maislos 2004 {published data only}
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- Maislos M, Weisman D. Multidisciplinary approach to patients with poorly controlled type 2 diabetes mellitus: a prospective, randomized study. Acta Diabetologica 2004;41(2):44-8. - PubMed
Mazzuca 1988 {published data only}
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- Mazzuca SA, Vinicor F, Cohen SJ, Norton JA, Fineberg NS, Fineberg SE, et al. The Diabetes Education Study: a controlled trial of the effects of intensive instruction of internal medicine residents on the management of diabetes mellitus. Journal of General Internal Medicine 1988;3(1):1-8. - PubMed
Mehler 2005 {published data only}
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- Mehler PS, Krantz MJ, Lundgren RA, Estacio RO, MacKenzie TD, Petralia L, et al. Bridging the quality gap in diabetic hyperlipidemia: a practice-based intervention. American Journal of Medicine 2005;118(12):1414. - PubMed
Polonsky 2011 {published data only}
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- Polonsky W H, Fisher L, Schikman C H, Hinnen D A, Parkin C G, Jelsovsky Z, et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study. Diabetes Care 2011;34(2):262-7. - PMC - PubMed
Saengtipbovorn 2014 {published data only}
Segal 2016 {published data only}
-
- Segal L, Nguyen H, Schmidt B, Wenitong M, McDermott RA. Economic evaluation of Indigenous health worker management of poorly controlled type 2 diabetes in north Queensland. Medical Journal of Australia 2016;204(5):1961e-9. - PubMed
Teychenne 2015 {published data only}
-
- Teychenne M, Ball K, Salmon J, Daly RM, Crawford DA, Sethi P, et al. Adoption and maintenance of gym-based strength training in the community setting in adults with excess weight or type 2 diabetes: a randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity 2015;12:105. - PMC - PubMed
Weitzman 2009 {published data only}
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- Weitzman S, Greenfield S, Billimek J, Hava T, Schvartzman P, Yehiel E, et al. Improving combined diabetes outcomes by adding a simple patient intervention to physician feedback: a cluster randomized trial. Israel Medical Association Journal 2009;11(12):719-24. - PubMed
References to studies awaiting assessment
Ali Abdelhamid 2021 {published data only}
-
- Ali Abdelhamid Y, Phillips LK, White MG, Presneill J, Horowitz M, Deane AM. Survivors of intensive care with type 2 diabetes and the effect of shared-care follow-up clinics: the SWEET-AS randomized controlled pilot study. Chest 2021;159(1):174-85. - PubMed
Alison 2020 {published data only}
-
- Alison C, Anselm S. The effectiveness of diabetes medication therapy adherence clinic to improve glycaemic control among patients with type 2 diabetes mellitus: a randomised controlled trial. Medical Journal of Malaysia 2020;75(3):246-53. - PubMed
Al‐Taie 2020 {published data only}
-
- Al-Taie A, Izzettin FV, Sancar M, Köseoğlu A. Impact of clinical pharmacy recommendations and patient counselling program among patients with diabetes and cancer in outpatient oncology setting. European Journal of Cancer Care 2020;29(5):e13261. - PubMed
Bohingamu Mudiyanselage 2019 {published data only}
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- Bohingamu Mudiyanselage S, Stevens J, Watts JJ, Toscano J, Kotowicz MA, Steinfort CL, et al. Personalised telehealth intervention for chronic disease management: a pilot randomised controlled trial. Journal of Telemedicine and Telecare 2019;25(6):343-52. - PubMed
Buysse 2020 {published data only}
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- Buysse H, Coremans P, Pouwer F, Ruige J. Sustainable improvement of HbA1c and satisfaction with diabetes care after adding telemedicine in patients on adaptable insulin regimens: Results of the TeleDiabetes randomized controlled trial. Health Informatics Journal 2020;26(1):628-41. - PubMed
Chen 2019 {published data only}
-
- Chen X, Jiang S, Xu Y, Tian Y. The effect of interactive health education based on the WeChat platform on diabetic outpatients. International Journal of Clinical and Experimental Medicine 2019;12(11):13154-62.
Daud 2020 {published data only}
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- Daud MH, Ramli AS, Abdul-Razak S, Haniff J, Tg-Abu-Bakar-Sidik TMI, Mohd-Hatta NKB, et al. Effectiveness of the EMPOWER-PAR intervention on primary care providers’ adherence to clinical practice guidelines on the management of type 2 diabetes mellitus: a pragmatic cluster randomized controlled trial. Open Access Macedonian Journal of Medical Sciences 2020;8(B):470-9.
Egede 2021a {published data only}
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- Egede LE, Dawson AZ, Walker RJ, Garraci E, Knapp RG. Randomized controlled trial of technology-assisted case management in low-income adults with type 2 diabetes: Effect on quality of life and blood pressure. Journal of Telemedicine and Telecare 2021;12:1357633X211028491. - PubMed
Egede 2021b {published data only}
Franc 2019 {published data only}
-
- Franc S, Joubert M, Daoudi A, Fagour C, Benhamou PY, Rodier M, et al, TeleDiab study group. Efficacy of two telemonitoring systems to improve glycaemic control during basal insulin initiation in patients with type 2 diabetes: The TeleDiab-2 randomized controlled trial. Diabetes, Obesity and Metabolism 2019;21(10):2327-32. - PMC - PubMed
Franc 2020 {published data only}
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- Franc S, Hanaire H, Benhamou PY, Schaepelynck P, Catargi B, Farret A, et al. DIABEO system combining a mobile app software with and without telemonitoring versus standard care: a randomized controlled trial in diabetes patients poorly controlled with a basal-bolus insulin regimen. Diabetes Technology & Therapeutics 2020;22(12):904-11. - PMC - PubMed
Gimbel 2020 {published data only}
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- Gimbel RW, Rennert LM, Crawford P, Little JR, Truong K, Williams JE, et al. Enhancing patient activation and self-management activities in patients with type 2 diabetes using the US Department of Defense mobile health care environment: feasibility study. Journal of Medical Internet Research 2020;22(5):e17968. - PMC - PubMed
Guo 2019 {published data only}
Heselmans 2020 {published data only}
Hu 2021 {published data only}
-
- Hu X, Deng H, Zhang Y, Guo X, Cai M, Ling C, Li K. Efficacy and safety of a decision support intervention for basal insulin self-titration assisted by the nurse in outpatients with T2DM: a randomized controlled trial. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2021;14:1315-27. - PMC - PubMed
Javaid 2019 {published data only}
Kang 2021 {published data only}
Khan 2021 {published data only}
Kim 2022 {published data only}
-
- Kim Y, Lee H, Seo JM. Integrated diabetes self-management program using smartphone application: a randomized controlled trial. Western Journal of Nursing Research 2022;44(4):383-94. - PubMed
Ku 2020 {published data only}
-
- Ku EJ, Park JI, Jeon HJ, Oh TK, Choi HJ. Clinical efficacy and plausibility of a smartphone-based integrated online real-time diabetes care system via glucose and diet data management: a pilot study. Internal Medicine Journal 2020;50(12):1524-32. - PubMed
Lee 2020 {published data only}
Lee 2020A {published data only}
Lou 2019 {published data only}
-
- Lou Q, Ye Q, Wu H, Wang Z, Ware RS, Xiong Y, et al. Effectiveness of a clinic-based randomized controlled intervention for type 2 diabetes management: an innovative model of intensified diabetes management in Mainland China (C-IDM study). BMJ Open Diabetes Research & Care 2019;8(1):e001030. - PMC - PubMed
Millan‐Ferro 2020 {published data only}
Murphy 2020 {published data only}
Noda 2020 {published data only}
Or 2020 {published data only}
Ramallo‐Farina 2020 {published data only}
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- Ramallo-Fariña Y, García-Bello MA, García-Pérez L, Boronat M, Wägner AM, Rodríguez-Rodríguez L, et al, INDICA Team. Effectiveness of internet-based multicomponent interventions for patients and health care professionals to improve clinical outcomes in type 2 diabetes evaluated through the indica study: multiarm cluster randomized controlled trial. JMIR Mhealth and Uhealth 2020;8(11):e18922. - PMC - PubMed
Reininger 2020 {published data only}
Rovner 2020 {published data only}
Ruiz de Adana 2020 {published data only}
-
- Ruiz de Adana MS, Alhambra-Expósito MR, Muñoz-Garach A, Gonzalez-Molero I, Colomo N, Torres-Barea I, et al, Diabetes Group of SAEDYN (Andalusian Society of Endocrinology, Diabetes, and Nutrition). Randomized study to evaluate the impact of telemedicine care in patients with type 1 diabetes with multiple doses of insulin and suboptimal HbA1c in Andalusia (Spain): PLATEDIAN Study. Diabetes Care 2020;43(2):337-42. - PubMed
Vaccaro 2013 {published data only}
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- Vaccaro O, Franzini L, Miccoli R, Cavalot F, Ardigo D, Boemi M, et al. Feasibility and effectiveness in clinical practice of a multifactorial intervention for the reduction of cardiovascular risk in patients with type 2 diabetes: the 2-year interim analysis of the MIND.IT study: a cluster randomized trial. Diabetes Care 2013;36(9):2566-72. - PMC - PubMed
von Storch 2019 {published data only}
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- Storch K, Graaf E, Wunderlich M, Rietz C, Polidori MC, Woopen C. Telemedicine-assisted self-management program for type 2 diabetes patients. Diabetes Technology & Therapeutics 2019;21(9):514-21. - PubMed
Wang 2019 {published data only}
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- Wang Y, Li M, Zhao X, Pan X, Lu M, Lu J, Hu Y. Effects of continuous care for patients with type 2 diabetes using mobile health application: a randomised controlled trial. International Journal of Health Planning and Management 2019;34(3):1025-35. - PubMed
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