Audio-Based Care for Managing Diabetes in Adults: A Systematic Review

Objectives: We compared the effectiveness of audio-based care, as a replacement or a supplement to usual care, for managing diabetes.

Background: Diabetes is a chronic condition afflicting many in the United States. The impact of audio-based care on the health of individuals with diabetes is unclear, particularly for those at risk for disparities-many of whom may only be able to access telehealth services through telephone.

Methods: We used systematic review methods to synthesize available evidence. We systematically searched for English-language articles from 2012 reporting randomized controlled trials of adults diagnosed with diabetes. We abstracted data on clinical outcomes (including A1c), patient-reported health and quality-of-life, health care access and utilization, care quality and experience, and patient safety.

Results: Evidence for replacing in-person care with audio care was limited (n = 2), with low certainty of evidence for greater and comparable effectiveness for A1c and harms, respectively. Supplemental audio care (n = 23) had a positive effect on A1c (pooled mean difference A1c -0.20%; n = 8763; 95% CI: -0.36% to -0.04%), with moderate certainty of evidence. Stratified results indicated that audio interventions supplementing usual care performed more favorably in individuals with A1c ≤ 9%; populations not at risk of disparities; interventions with at least monthly contact; and interventions using remote monitoring tools.

Conclusions: This evidence base reveals some promise for managing diabetes with audio-based care as a supplement to in-person care. Future studies could further investigate the effectiveness of audio-based care as a replacement and modify interventions to better serve individuals with poor glucose control and those at risk for disparities.