Comparing the effects of home visits and telenursing on blood glucose control: A systematic review of randomized controlled trials

Home visits have often been performed for diabetes management, but with the increased use of the internet and smartphones, people are opting for telenursing as the main method for monitoring and controlling diabetes. This study compares the effects of home visits and telenursing on diabetes management. Four electronic databases (MEDLINE, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature) were used as data sources. Glycated hemoglobin (HbA1c), fasting blood sugar, and two-hour post-prandial glucose levels were used as outcome measures. A subgroup analysis was performed based on the type of diabetes and follow-up. Of 1890 studies, 24 (2801 participants) were selected and meta-analyzed. The nursing interventions provided during nursing visits or telenursing mainly included education on diabetes and blood sugar control. It was seen that HbA1c decreased with a weighted mean difference of −0.66 (95 % confidence interval −0.82 to −0.51, p < .001) % in home visits and −0.56 (95 % confidence interval −0.81 to −0.31, p < .001) % in telenursing. The fasting blood sugar reported only in telenursing was reduced by a weighted mean difference of −14.23 (95 % confidence interval 27.59 to −0.88, p = .04) mg/dL and two-hour post-prandial glucose was reduced with a mean difference of −15.84 (95 % confidence interval −24.45 to −7.24, p = .003) mg/dL. Furthermore, low heterogeneity was found among the studies. In a subgroup analysis of diabetes type, HbA1c in home visits was reduced by −0.86 % in type 1 diabetes and −0.62 % in type 2 diabetes, while in telenursing, the reductions were −0.65 % and −0.53 %, respectively. Fasting blood glucose was reduced by −6.08 mg/dL and −18.50 mg/dL, respectively, whereas two-hour postprandial blood sugar was reduced by −14.49 mg/dL and −30.30 mg/dL, respectively, in telenursing. In the subgroup analysis of the follow-up period, HbA1c during home visits decreased by −0.63 % at 10 to 16 weeks, −0.73 % at 24 to 36 weeks, and −0.64 % at 52 weeks or more, while in telenursing, the reductions were −0.80 %, −0.44 %, and −0.07 %, respectively. Home visits were not statistically significant between 10 and 16 weeks, whereas telenursing was not significant at 52 weeks or more. Despite telenursing reducing HbA1c slightly less than home visits, evidence from this systematic review suggests that telenursing is a similarly effective approach for controlling blood glucose levels in patients with diabetes. Telenursing is a nursing intervention that can be used as an alternative to home visits for patients requiring diabetes management.