The Impact of Virtual Consultations on Quality of Care for Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis

Clinical Snapshot

Key Findings

• P Value: P = 0.12 (non-significant)

• Effect Size: Standardised Mean Difference (SMD) = -0.31, favouring virtual consultations numerically but not reaching statistical significance

• Primary Outcome: HbA1c reduction comparing virtual consultations versus face-to-face care in adults with Type 2 Diabetes

• Nnt Or Sensitivity: NNT not calculable from SMD alone; the wide CI (-0.71 to 0.09) spans from a potentially clinically meaningful HbA1c reduction to near-zero effect, indicating substantial imprecision. For non-HbA1c domains: VCs were comparable to face-to-face care for effectiveness, efficiency, patient-centeredness, and timeliness; mixed results for safety and equity.

• Confidence Interval: 95% CI: -0.71 to 0.09

Clinical Application

Synchronous VCs are technically feasible in most high-income healthcare systems with existing telehealth infrastructure. Key implementation barriers include patient digital literacy, device access, reliable internet connectivity, and clinician training in remote physical assessment limitations. Integration with remote monitoring devices (e.g., continuous glucose monitors, home blood pressure cuffs) may partially offset the physical examination deficit. Virtual consultations are directly relevant to Australian primary care following the permanent expansion of Medicare Benefits Schedule (MBS) telehealth items post-COVID-19 pandemic. The MBS currently funds telephone and video consultations for GP and specialist services, including chronic disease management under the Chronic Disease Management (CDM) item numbers. The RACGP supports telehealth as a complement to in-person care, particularly for rural and remote patients. The TGA has not specifically regulated synchronous VC as a medical device, but digital health tools used in conjunction require consideration under TGA frameworks. The equity findings are particularly salient for Australia given the digital divide affecting Aboriginal and Torres Strait Islander communities, elderly patients, and those in remote areas with limited broadband access. The National Diabetes Services Scheme (NDSS) and My Health Record infrastructure could facilitate VC integration. Clinicians should note that MBS telehealth items require an existing patient-provider relationship for most item numbers, and annual diabetes cycle-of-care requirements (including foot and eye checks) cannot be fully completed via VC alone. Adult patients with established Type 2 Diabetes managed in primary care or outpatient settings who have access to video or telephone consultation infrastructure and baseline digital literacy. Findings are less applicable to older adults, those with low digital literacy, or patients requiring physical examination components of diabetes review (e.g., foot assessment, retinal screening).

Abstract

BackgroundVirtual consultations (VC) have transformed healthcare delivery, offering a convenient and effective way to manage chronic conditions such as Type 2 Diabetes (T2D). This systematic review and meta-analysis evaluated the impact of VC on the quality of care provided to patients with T2D, mapping it across the six domains of the US National Academy of Medicine (NAM) quality-of-care framework (ie, effectiveness, efficiency, patient-centeredness, timeliness, safety, and equity).MethodsA systematic search was conducted in PubMed/MEDLINE, Cochrane, Embase, CINAHL, and Web of Science for the period between January 2010 and December 2024. Eligible studies involved adult T2D patients, evaluated synchronous VCs, and reported outcomes relevant to NAM quality domains. Two independent reviewers performed screening, and studies were assessed using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted for each quality domain, and a meta-analysis of HbA1c levels was performed using random-effects models.ResultsIn total, 15 studies involving 821 014 participants were included. VCs were comparable with face-to-face care in effectiveness, efficiency, patient-centeredness, and timeliness, with improvements in accessibility and patient satisfaction. Mixed results were found for safety due to limitations in physical assessments, and for equity, with older adults and those with lower digital literacy facing more challenges. The meta-analysis showed no significant difference in HbA1c reduction between VCs and face-to-face (standardized mean difference [SMD] = -0.31, 95% confidence interval [CI]: -0.71 to 0.09, P = 0.12).ConclusionVCs offer a promising alternative to in-person care, but addressing digital disparities and improving access for older adults are essential for maximizing VC potential.

References

1. 1.Aldakhil, R., Greenfield, G., Lammila-Escalera, E., Laranjo, L., Hayhoe, B. W. J., Majeed, A., & Neves, A. L. (2026). The impact of virtual consultations on quality of care for patients with Type 2 Diabetes: A systematic review and meta-analysis. Journal of Diabetes Science and Technology. https://doi.org/10.1177/19322968251316585