The impact of telemedicine interventions involving routine transmission of blood glucose data with clinician feedback on metabolic control in youth with type 1 diabetes: a systematic review and meta-analysis

Intensive glycemic control delays and preventsmicrovascular andmacrovascular complications of type 1 diabetes (T1DM) [1, 2]. Despite advances in insulin preparations and delivery mechanisms for insulin, glycemic control for many pediatric patients with T1DM remains suboptimal. An international study comparing glycemic control among pediatric diabetes centres failed to show a correlation with insulin regimen, suggesting that other factors, such as the organization of delivery of care and the number of staff on the diabetes team, may be critical to attaining optimal blood glucose control [3]. The intensive treatment protocol used in the Diabetes Control and Complications Trial (DCCT) included telephone contacts to adjust insulin regimens daily for the first week and then weekly thereafter. The intervention also involved an intensive insulin regimen, increased frequency of clinic visits, and intensive blood glucose monitoring [4]. Although shown to be effective in improving glycemic control, these intensive measures are not feasible to carry out in routine practice. Moreover, the particular challenges presented by youth with T1DM necessitate innovative management strategies [5]. One strategy for improving glycemic control is the use of telemedicine (TM). We distinguish routine T1DM management that may include solicited remote communication between patients and the diabetes team on an as-needed basis from TM interventions as defined in our study. We define TM to be the scheduled remote transmission of blood glucose (BG) data by means such as telephone, fax, mobile phone, or internet with unsolicited clinician feedback. This definition of TM is consistent with that used previously by authors of systematic reviews on this topic in the adult population with T1DM