Background: Worldwide, diabetes mellitus (DM) is a rapidly increasing chronic disease. The treatment of DM is individually adapted to achieve freedom from symptoms and to avoid acute complications as well as serious secondary diseases. In this context, the monitoring of vital parameters is an essential component of a comprehensive diabetes management. Telemonitoring is increasingly
used in this context. It is expected that this will improve self management as well as the achievement of individual therapy goals. The aim of the project is to provide decision support for a potential evaluation of telemedicine-assisted diabetes projects in Austria, based on international evidence on evaluation methods/instruments.

Methods: The present study contains a systematic review of evaluation methods and evidence of potential health care effects (taking into account the organisational setting) of telemedicine-assisted diabetes care programmes. First, a systematic search was conducted in five medical databases. The study selection and data extraction was done by two persons.

Results:

- Austrian telemedical care programmes: Currently, there are two telemedicine-assisted diabetes care programmes in Austria: „Diabcare” (in the Tyrol) and „Gesundheitsdialog Diabetes mellitus” (Austria-wide). Both care programmes aim to improve the self-management of diabetes patients. Both interventions are supported by digital health applications („DiabCare“ and „DiabMemory“). At present, however, these digital health applications are isolated solutions and must be compatible primarily with the doctor's software. A connection to the electronic health record (ELGA) is currently not possible, but planned. Both telemedicine-assisted diabetes care programmes have been or are being evaluated. A total of seven endpoints were measured in these evaluations with the help of standardised measuring instruments.

- Systematic review of evaluation methods: For the evaluation of international telemedicine-assisted diabetes projects, 20 studies (in 25 publications) were identified which measured a total of 17 outcomes. Most of the endpoints were assessed quantitatively (using standardised questionnaires). For the majority of the endpoints identified, patients were asked directly (self assessment). The following endpoints were collected for medical care effects: quality of life, functionality, frequency of hypo- and hyperglycaemia, cardiovascular risk/mortality, other clinical parameters. The following endpoints were collected for social care effects: knowledge of diabetes, experience with medical care, adherence to treatment recommendations, frequency of blood glucose measurements, satisfaction and acceptance, self management, self efficacy, psychological wellbeing. The following endpoints were collected for organisational care effects: therapy adjustments, use of medical services, use of the app/website, duration of study/programme participation.

- Systematic review on the additional benefit of telemedical care programmes: A total of 14 RCTs (with 74-1,665 participants) were included in the systematic review on the potential additional medical, social and organisational benefits of telemedicine-assisted diabetes projects compared to usual diabetes care. Evidence for health care effects could be identified, although there is a high heterogeneity of the respective programmes due to different organisational settings.

Conclusion: In addition to the medical benefits, organisational and social care effects should also be considered in telemedicine care programmes. The focus should be on those validated measurement instruments that have often been used in studies. In addition, routine data analyses are also possible and useful. The objectives and expectations of such telemedicine-assisted diabetes projects should determine the choice of measurement instruments.