Comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes

Mihiretu M Kebede,1–3 Manuela Peters,1,2 Thomas L Heise,1,2 Claudia R Pischke2 1Department of Public Health, University of Bremen, Health Sciences, Bremen, Germany; 2Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen...

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Autores principales:	Kebede MM, Peters M, Heise TL, Pischke CR
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Baseline imbalance ANCOVA Change scores Final values Meta-analysis HbA1c Type 2 Diabetes Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/8516577223ff4dbba6bf3369178b9750
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spelling	oai:doaj.org-article:8516577223ff4dbba6bf3369178b97502021-12-02T05:25:38ZComparison of three meta-analytic methods using data from digital interventions on type 2 diabetes1178-7007https://doaj.org/article/8516577223ff4dbba6bf3369178b97502018-12-01T00:00:00Zhttps://www.dovepress.com/comparison-of-three-meta-analytic-methods-using-data-from-digital-inte-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Mihiretu M Kebede,1–3 Manuela Peters,1,2 Thomas L Heise,1,2 Claudia R Pischke2 1Department of Public Health, University of Bremen, Health Sciences, Bremen, Germany; 2Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 3Department of Health Informatics, University of Gondar, College of Medicine and Health Science, Institute of Public Health, Gondar, Ethiopia Aims: Pooling the effect sizes of randomized controlled trials (RCTs) from continuous outcomes, such as glycated hemoglobin level (HbA1c), is an important method in evidence syntheses. However, due to challenges related to baseline imbalances and pre/post correlations, simple analysis of change scores (SACS) and simple analysis of final values (SAFV) meta-analyses result in under- or overestimation of effect estimates. This study was aimed to compare pooled effect sizes estimated by Analysis of Covariance (ANCOVA), SACS, and SAFV meta-analyses, using the example of RCTs of digital interventions with HbA1c as the main outcome.Materials and methods: Three databases were systematically searched for RCTs published from 1993 through June 2017. Two reviewers independently assessed titles and abstracts using predefined eligibility criteria, assessed study quality, and extracted data, with disagreements resolved by arbitration from a third reviewer.Results: ANCOVA, SACS, and SAFV resulted in pooled HbA1c mean differences of –0.39% (95% CI: [–0.51, –0.26]), –0.39% (95% CI: [–0.51, –0.26]), and –0.34% (95% CI: [–0.48–0.19]), respectively. Removing studies with both high baseline imbalance (≥±0.2%) and pre/post correlation of ≥±0.6 resulted in a mean difference of –0.39% (95% CI: [–0.53, –0.26]), –0.40% (95% CI: [–0.54, –0.26]), and –0.33% (95% CI: [–0.48, –0.18]) with ANCOVA, SACS, and SAFV meta-analyses, respectively. Substantial heterogeneity was noted. Egger’s test for funnel plot symmetry did not indicate evidence of publication bias for all methods.Conclusion: By all meta-analytic methods, digital interventions appear effective in reducing HbA1c in type 2 diabetes. The effort to adjust for baseline imbalance and pre/post correlation using ANCOVA relies on the level of detail reported from individual studies. Reporting detailed summary data and, ideally, access to individual patient data of intervention trials are essential. Keywords: baseline imbalance, ANCOVA, change scores, final values, systematic reviews, HbA1c, diabetes, eHealthKebede MMPeters MHeise TLPischke CRDove Medical PressarticleBaseline imbalanceANCOVAChange scoresFinal valuesMeta-analysisHbA1cType 2 DiabetesSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 12, Pp 59-73 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Baseline imbalance ANCOVA Change scores Final values Meta-analysis HbA1c Type 2 Diabetes Specialties of internal medicine RC581-951
spellingShingle	Baseline imbalance ANCOVA Change scores Final values Meta-analysis HbA1c Type 2 Diabetes Specialties of internal medicine RC581-951 Kebede MM Peters M Heise TL Pischke CR Comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes
description	Mihiretu M Kebede,1–3 Manuela Peters,1,2 Thomas L Heise,1,2 Claudia R Pischke2 1Department of Public Health, University of Bremen, Health Sciences, Bremen, Germany; 2Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 3Department of Health Informatics, University of Gondar, College of Medicine and Health Science, Institute of Public Health, Gondar, Ethiopia Aims: Pooling the effect sizes of randomized controlled trials (RCTs) from continuous outcomes, such as glycated hemoglobin level (HbA1c), is an important method in evidence syntheses. However, due to challenges related to baseline imbalances and pre/post correlations, simple analysis of change scores (SACS) and simple analysis of final values (SAFV) meta-analyses result in under- or overestimation of effect estimates. This study was aimed to compare pooled effect sizes estimated by Analysis of Covariance (ANCOVA), SACS, and SAFV meta-analyses, using the example of RCTs of digital interventions with HbA1c as the main outcome.Materials and methods: Three databases were systematically searched for RCTs published from 1993 through June 2017. Two reviewers independently assessed titles and abstracts using predefined eligibility criteria, assessed study quality, and extracted data, with disagreements resolved by arbitration from a third reviewer.Results: ANCOVA, SACS, and SAFV resulted in pooled HbA1c mean differences of –0.39% (95% CI: [–0.51, –0.26]), –0.39% (95% CI: [–0.51, –0.26]), and –0.34% (95% CI: [–0.48–0.19]), respectively. Removing studies with both high baseline imbalance (≥±0.2%) and pre/post correlation of ≥±0.6 resulted in a mean difference of –0.39% (95% CI: [–0.53, –0.26]), –0.40% (95% CI: [–0.54, –0.26]), and –0.33% (95% CI: [–0.48, –0.18]) with ANCOVA, SACS, and SAFV meta-analyses, respectively. Substantial heterogeneity was noted. Egger’s test for funnel plot symmetry did not indicate evidence of publication bias for all methods.Conclusion: By all meta-analytic methods, digital interventions appear effective in reducing HbA1c in type 2 diabetes. The effort to adjust for baseline imbalance and pre/post correlation using ANCOVA relies on the level of detail reported from individual studies. Reporting detailed summary data and, ideally, access to individual patient data of intervention trials are essential. Keywords: baseline imbalance, ANCOVA, change scores, final values, systematic reviews, HbA1c, diabetes, eHealth
format	article
author	Kebede MM Peters M Heise TL Pischke CR
author_facet	Kebede MM Peters M Heise TL Pischke CR
author_sort	Kebede MM
title	Comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes
title_short	Comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes
title_full	Comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes
title_fullStr	Comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes
title_full_unstemmed	Comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes
title_sort	comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/8516577223ff4dbba6bf3369178b9750
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Comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes

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