Open AccessImpact of Information Technology–Based Interventions for Type 2 Diabetes Mellitus on Glycemic Control: A Systematic Review and Meta-Analysis
Author(s) -
Nouf Alharbi,
Nada Alsubki,
Simon Jones,
Kamlesh Khunti,
Neil Munro,
Simon de Lusignan
Publication year - 2016
Publication title -
jmir. journal of medical internet research/journal of medical internet research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.446
H-Index - 142
eISSN - 1439-4456
pISSN - 1438-8871
DOI - 10.2196/jmir.5778
Subject(s) - psychological intervention , glycemic , medicine , meta analysis , medline , systematic review , type 2 diabetes mellitus , diabetes management , research design , diabetes mellitus , type 2 diabetes , intensive care medicine , family medicine , nursing , social science , sociology , political science , law , endocrinology
Background Information technology–based interventions are increasingly being used to manage health care. However, there is conflicting evidence regarding whether these interventions improve outcomes in people with type 2 diabetes. Objective The objective of this study was to conduct a systematic review and meta-analysis of clinical trials, assessing the impact of information technology on changes in the levels of hemoglobin A 1c (HbA 1c ) and mapping the interventions with chronic care model (CCM) elements. Methods Electronic databases PubMed and EMBASE were searched to identify relevant studies that were published up until July 2016, a method that was supplemented by identifying articles from the references of the articles already selected using the electronic search tools. The study search and selection were performed by independent reviewers. Of the 1082 articles retrieved, 32 trials (focusing on a total of 40,454 patients) were included. A random-effects model was applied to estimate the pooled results. Results Information technology–based interventions were associated with a statistically significant reduction in HbA 1c levels (mean difference −0.33%, 95% CI −0.40 to −0.26, P <.001). Studies focusing on electronic self-management systems demonstrated the largest reduction in HbA 1c (0.50%), followed by those with electronic medical records (0.17%), an electronic decision support system (0.15%), and a diabetes registry (0.05%). In addition, the more CCM-incorporated the information technology–based interventions were, the more improvements there were in HbA 1c levels. Conclusions Information technology strategies combined with the other elements of chronic care models are associated with improved glycemic control in people with diabetes. No clinically relevant impact was observed on low-density lipoprotein levels and blood pressure, but there was evidence that the cost of care was lower.