Do health information technology self-management interventions improve glycemic control in medically underserved adults with diabetes? A systematic review and meta-analysis

Elizabeth M. Heitkemper, Lena Mamykina, Jasmine Travers, Arlene Smaldone

Research output: Contribution to journalReview article

Abstract

Objective: The purpose of this systematic review and meta-analysis was to examine the effect of health information technology (HIT) diabetes self-management education (DSME) interventions on glycemic control in medically underserved patients. Materials and Methods: Following an a priori protocol, 5 databases were searched. Studies were appraised for quality using the Cochrane Risk of Bias assessment. Studies reporting either hemoglobin A1c pre- and post-intervention or its change at 6 or 12 months were eligible for inclusion in themeta-analysis using random effectsmodels. Results: Thirteen studies met the criteria for the systematic review and 10 for the meta-analysis and represent data from 3257 adults with diabetes (mean age 55 years; 66% female; 74% racial/ethnic minorities). Most studies (n=10) reflected an unclear risk of bias. Interventions varied by HIT type: computer software without Internet (n=2), cellular/automated telephone (n=4), Internet-based (n=4), and telemedicine/telehealth (n=3). Pooled A1c decreases were found at 6 months (-0.36 (95% CI, -0.53 and -0.19]; I2=35.1%, Q=5.0), with diminishing effect at 12 months (-0.27 [95% CI, -0.49 and -0.04]; I2=42.4%, Q=10.4). Discussion: Findings suggest that medically underserved patients with diabetes achieve glycemic benefit following HIT DSME interventions, with dissipating but significant effects at 12 months. Telemedicine/telehealth interventions were the most successful HIT type because they incorporated interaction with educators similar to in-person DSME. Conclusion: These results are similar to in-person DSME in medically underserved patients, showing that welldesigned HIT DSME has the potential to increase access and improve outcomes for this vulnerable group.

Original languageEnglish (US)
Article numberocx025
JournalJournal of the American Medical Informatics Association
Volume24
Issue number5
DOIs
StatePublished - 2017

Keywords

  • Health information technology
  • Medically underserved/health disparities
  • Meta-analysis
  • Self-management
  • Type 2 diabetes

ASJC Scopus subject areas

  • Health Informatics

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