远程医疗改善妊娠期糖尿病患者血糖和妊娠结局有效性和安全性的系统评价

Efficacy and safety of telemedicine for blood glucose and pregnancy outcomes in gestational diabetes mellitus: a systematic review

目的系统评价远程医疗改善妊娠期糖尿病患者血糖和妊娠结局的效果。方法计算机检索TheCochrane Library、PubMed、Web of Science、CINAHL、Scopus、CBM、CNKI、WanFang Data和VIP数据库,搜集有关远程医疗对妊娠期糖尿病患者血糖和妊娠结局影响的随机对照试验(RCT),检索时限均从建库至2019年1月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入10个RCT,包括1 267例患者。Meta分析结果显示:接受远程医疗管理的妊娠期糖尿病患者与门诊随访患者在空腹血糖[MD=-0.34,95%CI(-1.62,0.93),P=0.60]、糖化血红蛋白[MD=-0.22,95%CI(-0.61,0.17),P=0.27]、分娩孕周[MD=0.03,95%CI(-0.13,0.19),P=0.72]、早产率[OR=0.52,95%CI(0.26,1.01),P=0.05]、剖宫产率[OR=0.87,95%CI(0.57,1.31),P=0.51]、新生儿出生体重[MD=13.01,95%CI(-45.75,71.78),P=0.66]、巨大儿发生率[OR=1.16,95%CI(0.83,1.62),P=0.40]、妊娠期高血压和先兆子痫的发生率[OR=1.04,95%CI(0.52,2.09),P=0.91]、新生儿低血糖发生率[OR=1.21,95%CI(0.75,1.95),P=0.44]和新生儿黄疸发生率[OR=1.09,95%CI(0.59,2.00),P=0.78]的差异均无统计学意义。而接受远程医疗管理的妊娠期糖尿病患者餐后2 h血糖更低[MD=-3.45,95%CI(-5.53,-1.37),P=0.001],其差异有统计学意义。结论现有证据表明,远程医疗管理与常规门诊随访管理妊娠期糖尿病患者血糖水平和妊娠结局方面的有效性和安全性相似。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objectives To systematically review the efficacy of telemedicine on blood glucose level and pregnancy outcomes in patients with gestational diabetes mellitus.Methods The Cochrane Library,PubMed,Web of Science,CINAHL,Scopus,CBM,CNKI,WanFang Data and VIP databases were electronically searched to collect randomized controlled trials(RCTs)on efficacy of telemedicine on blood glucose and pregnancy outcomes in patients with gestational diabetes from inception to January 1st,2019.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,and then meta-analysis was performed by RevMan 5.3 software.Results A total of 10 RCTs involving 1 267 patients were included.The results of meta-analysis showed that there were no statistical significances in fasting blood glucose(MD=-0.34,95%CI-1.62 to 0.93,P=0.60),HbA1c(MD=-0.22,95%CI-0.61 to 0.17,P=0.27),gestational age at delivery(MD=0.03,95%CI-0.13 to 0.19,P=0.72),premature rate(OR=0.52,95%CI 0.26 to 1.01,P=0.05),caesarean delivery rate(OR=0.87,95%CI 0.57 to 1.31,P=0.51),infant birth weight(MD=13.01,95%CI-45.75 to 71.78,P=0.66),large for gestational age rate(OR=1.16,95%CI 0.83 to 1.62,P=0.40),preeclampsia/pregnancy induced hypertension rate(OR=1.04,95%CI 0.52 to 2.09,P=0.91),neonatal hypoglycaemia rate(OR=1.21,95%CI 0.75 to 1.95,P=0.44)and neonatal jaundice rate(OR=1.09,95%CI 0.59 to 2.00,P=0.78)between telemedicine management and outpatient follow-up of gestational diabetes mellitus.However,the telemedicine management group had lower 2h postprandial blood glucose(MD=-3.45,95%CI-5.53 to-1.37,P=0.001).Conclusions The current evidence shows that telemedicine management of gestational diabetes mellitus achieves similar efficacy and safety in blood glucose level and pregnancy outcomes as outpatient follow-up.Due to limited quality and quantity of the included studies,more high quality studies are required to verify the above conclusions.