Design: Systematic review and meta-analysis of randomised trials
Population: 23 trials, 3055 women with gestational diabetes
Primary outcome: Glycaemic control and maternal and neonatal outcomes
Effect: Fasting glucose MD -0.26 (95% CI -0.42 to -0.09); I² >90%; GRADE low to very low

A meta-analysis in the Journal of Medical Internet Research pooled 23 randomised trials covering 3055 women with gestational diabetes (GDM), comparing telemedicine-supported care with standard in-person care.

Pooled results favoured telemedicine for fasting glucose (mean difference -0.26 mmol/L), two-hour post-meal glucose (-0.50) and gestational weight gain (-0.78 kg). It was also associated with fewer caesarean sections, macrosomia, neonatal hypoglycaemia and respiratory distress. HbA1c, preterm birth and neonatal intensive care admission did not differ.

The weakness is large: heterogeneity for the glucose and weight outcomes exceeded 90%, the prediction intervals crossed zero, and GRADE certainty was low to very low throughout. The trials used very different interventions under one label.

For Indian practice, where travel to antenatal clinics is a real barrier, remote glucose review is a sensible supplement. It should add to antenatal visits, not replace them.

Consider remote review of home glucose logs for women with GDM who struggle to attend often
Keep scheduled in-person antenatal visits and growth scans alongside any telemedicine
Set clear thresholds for when a remote reading should trigger a call or a visit
Do not expect HbA1c to show the benefit; review fasting and post-meal readings instead

Why it matters

Remote glucose review may help most where clinic access is worst, but the evidence cannot yet say how much.

The statistics, in plain English

An I² above 90% means the trials disagreed far more than chance would explain. The 95% prediction interval, which estimates the range a new trial might show, crossed zero, so a future study could reasonably find no benefit at all.