A Systematic Review on the Impact of Electronic Consultations on Diabetes Care

Primary care physicians (PCPs) are increasingly challenged with managing glycemic control in people with diabetes (PWD), especially in the setting of a shortage in endocrinologists. Electronic consultations (e-consults), which enable asynchronous communication between PCPs and specialists through electronic health records, have been introduced to address these issues. This systematic review aims to evaluate the impact of e-consults on glycemic control in PWD, focusing on changes in HbA1c levels.

Two independent reviewers searched PubMed, EMBASE, and the Cochrane Library, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The review encompasses randomized controlled trials and observational studies. Two reviewers extracted data pertaining to prespecified outcomes of each interest from each included study.

Summary tables and narrative synthesis were used (PROSPERO 2024 CRD42024503278). Six studies were included, -two randomized controlled trials and 4 observational studies-assessing the role of e-consults in diabetes care. Most studies did not report significant differences in HbA1c levels between e-consult and control groups. However, benefits such as improved medication usage, reduced costs, enhanced access to specialist care, shorter wait times for in-person visits, and better educational opportunities for PCPs were noted. Implementation barriers included PCP familiarity with e-consults and patient adherence. Limitations include inclusion of only 2 trials and 4 observational studies and heterogeneity between them.

E-consults provide valuable benefits in managing diabetes, particularly in resource-limited settings. E-consults offer a promising solution to the endocrinologist shortage, though further research is needed to identify which PWD would benefit most.