TY  - JOUR
AU  - Li, Yang
AU  - Yang, Yue
AU  - Liu, Xiaoqin
AU  - Zhang, Xinting
AU  - Li, Fei
PY  - 2025
DA  - 2025/4/10
TI  - Effectiveness of Telemedicine-Delivered Carbohydrate-Counting Interventions in Patients With Type 1 Diabetes: Systematic Review and Meta-Analysis
JO  - J Med Internet Res
SP  - e59579
VL  - 27
KW  - type 1 diabetes
KW  - hemoglobin A1c
KW  - telemedicine
KW  - carbohydrate counting
KW  - review
AB  - Background: Type 1 diabetes mellitus (T1DM) significantly affects patients’ quality of life and can be life-threatening, necessitating improved monitoring strategies. Telemedicine, which leverages telecommunications technologies to deliver health care services and expertise, has the potential to enhance T1DM management. However, its effectiveness remains to be fully established. Objective: This study aims to evaluate the effectiveness of various telemedicine-based carbohydrate-counting (CC) interventions in patients with T1DM. Methods: This systematic review and meta-analysis searched 5 databases—PubMed, Web of Science, CINAHL, Embase, and Cochrane—as well as reference lists of retrieved articles on September 26, 2024, for randomized controlled trials (RCTs) assessing the effectiveness of telemedicine-based CC interventions in reducing glycated hemoglobin A1c (HbA1c) levels in patients with T1DM. Results: From 3612 citations, we identified 18 eligible RCTs (n=1627) from 14 regions for inclusion in the meta-analysis. Participants in the telemedicine intervention group experienced a 0.35% reduction in HbA1c levels (95% CI –0.54 to –0.16) compared with the control group. A total of 13 studies used smartphone apps, 4 used connected and wearable glucometers, and 3 delivered the intervention through web-based systems. Significant reductions in HbA1c were observed across smartphone apps (–0.36%, 95% CI –0.63% to –0.09%), connected and wearable glucometers (–0.35%, 95% CI –0.56% to –0.14%), and web-based systems (–0.36%, 95% CI –0.71% to –0.02%). Considerable heterogeneity was noted (I2=81%, P<.001). Telemedicine-based CC interventions also increased time in range by 9.59% (95% CI 6.50%-12.67%). However, evidence regarding treatment satisfaction, total daily insulin dose, and hypoglycemia remains inconclusive. Subgroup analysis showed that telemedicine platform variety did not significantly contribute to heterogeneity, while meta-regression indicated that the impact on HbA1c was most pronounced in trials conducted in Asia. Conclusions: Compared with usual care, telemedicine-delivered CC interventions improved HbA1c and time in range but did not significantly impact other clinically relevant outcomes in patients with T1DM. High-quality, large-scale RCTs are needed to draw definitive conclusions. These findings provide health care professionals with updated evidence on the role of telemedicine in glycemic control for patients with T1DM. Trial Registration: PROSPERO CRD42024523025; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024523025 
SN  - 1438-8871
UR  - https://www.jmir.org/2025/1/e59579
UR  - https://doi.org/10.2196/59579
UR  - http://www.ncbi.nlm.nih.gov/pubmed/39965802
DO  - 10.2196/59579
ID  - info:doi/10.2196/59579
ER  -