TY - JOUR
T1 - Do health information technology self-management interventions improve glycemic control in medically underserved adults with diabetes? A systematic review and meta-analysis
AU - Heitkemper, Elizabeth M.
AU - Mamykina, Lena
AU - Travers, Jasmine
AU - Smaldone, Arlene
N1 - Publisher Copyright:
© The Author 2017.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - 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.
AB - 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.
KW - Health information technology
KW - Medically underserved/health disparities
KW - Meta-analysis
KW - Self-management
KW - Type 2 diabetes
KW - Humans
KW - Male
KW - Self-Management
KW - Medical Informatics
KW - Female
KW - Diabetes Mellitus/blood
KW - Glycated Hemoglobin A/analysis
KW - Patient Education as Topic
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U2 - 10.1093/jamia/ocx025
DO - 10.1093/jamia/ocx025
M3 - Review article
C2 - 28379397
AN - SCOPUS:85032870225
SN - 1067-5027
VL - 24
JO - Journal of the American Medical Informatics Association
JF - Journal of the American Medical Informatics Association
IS - 5
M1 - ocx025
ER -