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Telephone follow-up to improve glycaemic control in patients with Type 2 diabetes: systematic review and meta-analysis of controlled trials


Dr Angus Forbes, King’s College London, Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK. E-mail:


Diabet. Med. 27, 1217–1225 (2010)


Objective  To examine the impact of telephone follow-up interventions on glycaemic control in patients with Type 2 diabetes.

Methods  This was a systematic review and meta-analysis of randomized controlled trials using The Cochrane Library, including the Cochrane central register of controlled trials; MEDLINE, EMBASE, PsycINFO and CINHAL, together with citation searching. The included studies were randomized controlled trials examining the effect of a telephone follow-up intervention on glycaemic control in patients with Type 2 diabetes. All the included trials were subject to critical appraisal. Data were extracted on study design, characteristics of patients, exact nature of the telephone intervention and details of comparison. Pooled standardized effects were calculated for the primary outcome. Glycaemic control was measured by HbA1c.

Results  HbA1c levels reported in the reviewed studies were pooled using random effects models. The standardized effect of telephone follow-up was equivocal, with endpoint data showing weighted mean differences of –0.44 (95% CI –0.93 to 0.06) (Z = –1.72, P = 0.08) in favour of the telephone follow-up intervention. Subgroup analysis of more intensive interventions (interactive follow-up with health professional plus automated follow-up or non-interactive follow-up) showed (n = 1057) a significant benefit in favour of the treatment group, with a standardized mean difference of –0.84 (95% CI –1.67 to 0.0) (Z = 1.97, P = 0.05), indicating that more intensive (targeted) modes of follow-up may have better effects on glycaemic control.

Conclusions  The analysis suggested that telephone follow-up interventions following a more intensive targeted approach could have a positive impact on glycaemic control for Type 2 diabetes.