Effect of virtual care in type 2 diabetes management - a systematic umbrella review of systematic reviews and meta-analysis

BackgroundDiabetes is an increasingly prevalent and costly chronic disease worldwide, and a large cause of unnecessary disease burden. To address the growing burden of diabetes, care models should support management of diabetes in primary care to reduce reliance on overstretched hospital-based specialists services. Virtual care presents an opportunity to provide diabetes care remotely, potentially enhancing the accessibility and efficiency of healthcare services. This review aimed to identify existing evidence on the effectiveness of virtual care on diabetes management, and the extent to which video components are included in the evidence base.MethodsThe protocol was registered in PROSPERO (CRD42022366125). Systematic search of the databases PubMed, Embase, Medline, Scopus, CINAHL and Cochrane CENTRAL, were conducted for studies on telemedicine, telehealth, or virtual interventions for type 2 diabetes management published between January 2011 to March 2022. The primary outcome was HbA1c, and secondary outcomes were blood glucose control, Body Mass Index (BMI), taking the prescribed medications, and self-management behaviour. The results were reported following the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist. Quality of each review was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Systematic Reviews and Research Syntheses.ResultsFrom 10,708 articles, 63 underwent full-text review. Thirty systematic reviews were included. Overall quality of the included reviews was high. Among the 30 systematic reviews, there was significant overlap of the primary studies, with 48% of them appearing in multiple reviews. Of the 30 reviews, 28 reported that virtual care improved HbA1c compared to usual care. Meta-analysis of 16 reviews revealed a mean difference of -0.37% (-0.41% to -0.32%), I2 of 77.1%. Significant non-clinical impacts were noted for BMI and secondary outcomes. Most reviews (25/30) included some studies with video components, however these studies did not disaggregate the impact of video from other aspects of complex interventions such as web-based and telephone support.ConclusionsThis umbrella review strengthens the evidence that virtual care significantly improves clinical outcomes in people with type 2 diabetes, primarily affecting HbA1c. Fewer studies addressed other health outcomes such as BMI and taking medications. Effectiveness of virtual care varies by demographic and clinical characteristics, emphasising the need to tailor virtual care interventions to maximise impact. Future research could directly compare and identify the most effective virtual care strategies for different populations, including those with lower digital literacy.