Systematic Review And Meta-Analysis

1. Cellular Phone-Based Technologies For Monitoring Of Patients With Diabetes: a Systematic Review and Meta Analysis Systematic Review And Meta-Analysis Class 3 Professor Doutor João Fonseca Introdução à Medicina II

2. Mobile phone based tecnhologies Chronic diseases 60% of all deaths [1] Slow progression Applied in management of diseases [3] Introduction Increasinginternationalinterest[2] [1]http://www.who.int/en/, availableon1-11-2007 [2] Hilary Pinnock, Roger Slack, Claudia Pagliari, David Price, Aziz Sheikh; Understandingthepotential role of mobile phone-basedmonitoringonasthmaself-management: qualitativestudy; Clinical and Experimental Allergy. 2007 May;Kollmann et al., 20077(5):794-802; Available at: www.pubmed.com 26-10-2007. [3] Ryan D, Cobern W, Wheeler J, Price D, Tarassenko L; Mobile Phone Technology in the Management of Asthma; Journal of Telemedicine and Telecare 2005; 11 Suppl 1:4Kollmann et al., 2007-6; Available at: www.pubmed.com 26-10-2007

3. Healthcare professional Communication of adapted treatment Quickly communication of symptoms (4] Patient with diabetes Fig. 1_ The role of CPT inthemonitoringofpatientswithchronicdiseases [4] Morak J, Kollmann A, Schreier G; Feasibility and usability of a home monitoring concept based on mobile phones and near field communication (NFC) technology; Medinfo. 2007; 12 (Pt 1):112-6; Available at: www.pubmed.com 26-10-2007.

4. Diabetes High mortality High morbidity Increasing prevalence in society [5] Clear and structured article Focused article Selectionofonedisease [5] AMOS A. F; MCCARTY D. J.; ZIMMET P., The rising global burden of diabetes and its implications: estimates and projections to the year 2010 ;Diabetic medicine ; 1997, vol.14, pp S7-S84, SUP5

5. Outcome Patients’ medical state Glycosylated haemoglobin Fasting plasmatic glycemia

6. Research question “Does cellularphonebasedtecnhologiesmonitoringimprove diabetes patients’ clinicaloutcomes?”

8. Systematic review and meta-analysis present summarize Evidence collected from articles search

9. Query ((monitoring) OR (telemonitoring)) AND ((cellular phone-based technologies) OR (mobile phone-based technologies) OR (cellular phone) OR (mobile phone)) AND ((chronic diseases) OR (chronic patients) OR (cancer) OR (nephrologic diseases) OR (kidney insufficiency) OR (asthma) OR (respiratory chronic diseases) OR (COPD) OR (diabetes) OR (cardiovascular disease)).

10. Articles Obtained Isi Web of knowledge Pubmed Scopus Total 160 51 45 64

11. Groups of two people read the abstracts 50 repeated articlesamongdatabases 9 articleswithoutabstract applied Inclusion/ exclusion criteria selected 21 articles

12. Articlesperdisease Graphic 1_ Distribuitionofdiseasesamongobtainedarticles

13. Inclusion criteria Exclusion criteria • Articles published in the last 10 years • Articles containing original data • Cellular phone-based technologies (CPT)‏ • Articles about the application of CPT in patients • Articles regarding diabetes • Articles regarding comparison studies • Articles regarding the evolution of the clinical state of the patient • Articles in English, Spanish and French • Use of cellular-phone for interviewing patients about other issues unrelated to disease monitoring • Articles that describe technologies and their development

14. Reading of full texts 21 articles 6 articleswithoutfull-text applied Inclusion/ exclusion criteria were obtained 8 articles

15. A group of two people read 8 articles 3 were repeated within databases selected 5 articles

16. Reading of full texts 5 articles for Extraction of variables Followed by Statistical analysis

17. Variables year of publication glycosylatedhemoglobin Control/intervention country of origin type of study Fasting plasmatic glycemia Control/intervention n intervention n controls Children : 0-14 Youth: 15-17 Adults: 18-65 Elderly: +65 age group

18. Table 1. _ Quality Criteria used to evaluate the final articles included, adapted from “Extending the CONSORT Statement to Randomized Trials of Nonpharmacologic Treatment: Explanation and Elaboration”

19. Table 2_Classification according to qualitycriteria

21. Table 3_ Includedarticlescharacteristics

22. Table 4_Secundary variables.

23. Table 5_ Extractedvariables

24. Table 6_ data regarding dependent variables used to perform the meta-analysis. The values were extracted from the included articles and analysed using RevMan. Some data is absent due to lack of information in the articles

26. Graphic 2_ Glycosilatedhaemoglobinforestplot

27. Graphic 3_ Fastingplasmaticglycemiaforestplot.

28. References [1]http://www.who.int/en/, available on 1-11-2007 [2] Hilary Pinnock, Roger Slack, Claudia Pagliari, David Price, Aziz Sheikh; Understanding the potential role of mobile phone-based monitoring on asthma self-management: qualitative study; Clinical and Experimental Allergy. 2007 May;Kollmann et al., 20077(5):794-802; Available at: www.pubmed.com 26-10-2007. [Kollmann et al., 2007] Ryan D, Cobern W, Wheeler J, Price D, Tarassenko L; Mobile Phone Technology in the Management of Asthma; Journal of Telemedicine and Telecare 2005; 11 Suppl 1:4Kollmann et al., 2007-6; Available at: www.pubmed.com 26-10-2007 [4] Morak J, Kollmann A, Schreier G; Feasibility and usability of a home monitoring concept based on mobile phones and near field communication (NFC) technology; Medinfo. 2007; 12 (Pt 1):112-6; Available at: www.pubmed.com 26-10-2007. [5] AMOS A. F; MCCARTY D. J.; ZIMMET P., The rising global burden of diabetes and its implications: estimates and projections to the year 2010; Diabetic medicine ; 1997, vol.14, pp S7-S84, SUP5

29. Class 3 Susana Carrilho Sara Coelho Fernando Sá Diogo Miguel Alexandra Azevedo Ana Pessoa Ana Lisboa Ana Luísa Graça Pedro Lopes Ana Luísa Padilhó Joana Carvalho Maycoll Vieira Pedro Souteiro