TELEMEDICINE AND MOBILE HEALTH IN TYPE 2 DIABETES SELF-MANAGEMENT: EFFECTIVENESS, SAFETY, AND THE CASE FOR HYBRID CARE

Abstract

Background: Type 2 diabetes mellitus requires sustained self-management and regular clinical assessment. Telemedicine and mobile health may improve continuity of care, although their value varies with service design, patient capability, and professional oversight. Aim: To critically evaluate the effectiveness, safety, equity, and appropriate clinical use of telemedicine and mobile health in adults with type 2 diabetes mellitus. Material and Methods: Peer-reviewed literature was identified in PubMed, with Google Scholar used for supplementary citation searching. Current clinical standards, systematic reviews, meta-analyses, randomized trials, safety assessments, and qualitative studies were included in a narrative synthesis. Results: Digital interventions produced modest average reductions in glycated hemoglobin, but results varied substantially between studies and were neutral in a primary-care meta-analysis. Benefit was more evident in patients with higher baseline HbA1c and in services combining monitoring with medication adjustment or responsive professional feedback. Relevant risks included digital exclusion, unvalidated dosing advice, unclear clinical responsibility, additional professional workload, and omission of necessary physical examination. Conclusions: Telemedicine should complement rather than replace direct care. A hybrid model integrating remote monitoring with defined escalation procedures, accountable professional review, and periodic or clinically indicated face-to-face assessment is the most defensible approach.