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J Am Med Inform Assoc. 2017 Sep 1;24(5):1024-1035. doi: 10.1093/jamia/ocx025.

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

Author information

1
School of Nursing, Columbia University Medical Center, New York, NY, USA.
2
Department of Biomedical Informatics, Columbia University Medical Center.
3
School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
4
Department of Dental Behavioral Sciences, College of Dental Medicine, Columbia University Medical Center.

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 the meta-analysis using random effects models.

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]; I 2  = 35.1%, Q  = 5.0), with diminishing effect at 12 months (-0.27 [95% CI, -0.49 and -0.04]; I 2  = 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 well-designed HIT DSME has the potential to increase access and improve outcomes for this vulnerable group.

KEYWORDS:

health information technology; medically underserved/health disparities; meta-analysis; self-management; type 2 diabetes

PMID:
28379397
PMCID:
PMC6080842
DOI:
10.1093/jamia/ocx025
[Indexed for MEDLINE]
Free PMC Article

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