Remotely delivered monitoring and management of diabetes-related foot disease: an overview of systematic reviews

Drovandi, Aaron, Wong, Shannon, Seng, Leonard, Crowley, Benjamin, Alahakoon, Chanika, Banwait, Jasmin, Fernando, Malindu E., and Golledge, Jonathan (2021) Remotely delivered monitoring and management of diabetes-related foot disease: an overview of systematic reviews. Journal of Diabetes Science and Technology. (In Press)

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DOI: 10.1177%2F19322968211012456
View at Publisher Website: https://doi.org/10.1177%2F19322968211012...
 
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Abstract

Background: Diabetes-related foot disease (DFD) management requires input from multiple healthcare professionals, and has worse outcomes for people living in remote localities by comparison to urban areas. Remotely delivered healthcare may reduce this disparity. This overview summarizes current evidence on the effectiveness, stakeholder perceptions, and cost-effectiveness of remotely delivered healthcare for DFD.

Methods: A search of 5 databases was conducted to identify systematic reviews published between January 2000 and June 2020. Eligible reviews were those evaluating remotely delivered monitoring or management of patients at risk of or with active DFD, or clinicians managing these patients. Risk of bias was assessed using the AMSTAR-2 tool.

Results: Eight reviews were eligible for inclusion, including 88 primary studies and 8509 participants, of which 36 studies involving 4357 participants evaluated remotely delivered monitoring or management of DFD. Only one review had a low risk of bias, with most reviews demonstrating limited search strategies and poor reporting of participants. Evidence on effectiveness was mixed, with meta-analyses demonstrating long-term ulcer healing and mortality were not significantly different between telehealth and standard care groups, although the lower-limb amputation rate was significantly decreased in one meta-analysis. Perceptions of telehealth by patients and clinicians were generally positive, whilst acknowledging limitations relating to access and use. Cost-effectiveness data were limited, with poor reporting preventing clear conclusions.

Conclusions: Remotely delivered healthcare of DFD is well received by patients and clinicians, but its effectiveness is unclear. High quality trials are needed to evaluate the risks and benefits of remotely delivered DFD management.

Item ID: 69587
Item Type: Article (Research - C1)
ISSN: 1932-2968
Keywords: diabetic foot disease, diabetic foot ulcer, telehealth, telemedicine, umbrella review
Copyright Information: © 2021 Diabetes Technology Society
Funders: James Cook University (JCU), National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC 1117061
Date Deposited: 14 Oct 2021 01:15
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 100%
SEO Codes: 20 HEALTH > 2003 Provision of health and support services > 200399 Provision of health and support services not elsewhere classified @ 100%
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