Verhoevan and coworkers reviewed the literature to determine the benefits of teleconsultation and video conferencing on processes of diabetes care. More specifically, the objective was to determine the benefits and deficiencies of teleconsultation and video conferencing regarding clinical, behavioral, and care coordination outcomes of diabetes care. A number of databases were examined. The contribution to diabetes care was examined for clinical outcomes (e.g., HbA(1c), blood pressure, quality of life), behavioral outcomes (patient-caregiver interaction, self-care), and care coordination outcomes (usability of technology, cost-effectiveness, transparency of guidelines, equity of care access). Randomized controlled trials with HbA(1c) as an outcome were pooled using standard analytical methods. Of 852 publications identified, 39 met the inclusion criteria for electronic communication between caregivers and patients with type 1, type 2, or gestational diabetes. Studies that evaluated teleconsultation or video conferencing not particularly aimed at diabetes were excluded, as were those that described interventions aimed solely at clinical improvements (e.g., HbA(1c)). There were 22 interventions related to teleconsultation, 13 to video conferencing, and 4 to combined teleconsultation and video conferencing. The heterogeneous nature of the studies did not permit a formal meta-analysis. However, pooled results from the six controlled trials of tele-consultation studies did not show a significant reduction in HbA(1c) compared to usual care. Most of the reported improvements concerned satisfaction with technology (26/39 studies), improved metabolic control (21/39), and cost reductions (16/39). Improvements in quality of life (6/39 studies), transparency (5/39), and better access to care (4/39) were hardly observed. Tele-consultation programs involving daily monitoring of clinical data, education, and personal feedback proved to be most successful in realizing behavioral change and reducing costs. The benefits of video conferencing were mainly related to its effects on socioeconomic factors such as education and cost reduction, but also on monitoring disease. In addition, video conferencing seemed to maintain quality of care while producing cost savings.

VALUE OF STUDY TO READER: The analysis suggest that both teleconsultation and video conferencing are practical, cost-effective, and reliable ways of delivering health care service to diabetics. However, the diversity in study design and reported findings makes conclusions difficult. To further the contribution of technology to diabetes care, interactive systems should be developed that integrate monitoring and personalized feedback functions. Equally important, is that self-management be at the core of whatever program is used with patients taught via either telecommunication or video conferencing.

V Verhoeven et al. The contribution of teleconsultation and video conferencing to diabetes care: a systematic literature review. Journal of Medical Internet Research, 2007;9:e37.