遠距醫療照護對糖尿病足潰瘍患者癒合時間、截肢率與死亡率之影響：系統性文獻回顧與統合分析

The Effects of Telemedicine on Healing Time, Amputation Rate, and Mortality in Patients with Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

糖尿病影響全球5.89億人，容易引發足部潰瘍，當傷口照護不佳、反覆感染，易導致截肢和死亡，因此良好控制血糖和密切觀察傷口，非常重要。近年，遠距醫療照護，已用於糖尿病足潰瘍患者之照護，然而其成效未有定論。本篇研究探討遠距醫療照護對糖尿病足潰瘍患者癒合時間、截肢率與死亡率之成效。以中、英文關鍵字，P：糖尿病足潰瘍患者（Patient with Diabetic Foot Ulcers）；I：遠距醫療照護（Telemedicine）；C：門診治療（OPD Treatment）；O：傷口癒合（Wound Healing）、截肢率（Amputation Rate）及死亡率（Mortality），搜尋1947-2025年PubMed、Embase、Cochrane Library、華藝線上圖書館與中國知網（CNKI）五個電子資料庫。運用2020年PRISMA篩選流程，以RoB 2.0、Modified Jadad Scale與ROBINS-I V2工具進行文獻品質評析。運用Comprehensive Meta-Analysis Version 3.0軟體進行統合分析。共獲得66篇文章，嚴格篩選後共納入5篇隨機實驗性研究（1,225名）和3篇類實驗性研究（1,085名）糖尿病足潰瘍患者，統合分析結果顯示，遠距醫療顯著降低截肢率（OR=0.649，95％CI：0.457-0.920；p<0.02），但在癒合時間、癒合率、十二個月死亡率則未顯著影響（p>0.05）。遠距醫療照護，能降低糖尿病足潰瘍患者的截肢率，且在癒合時間、癒合率、十二個月死亡率，與傳統門診照護的成效相當，因此建議妥善運用遠距醫療照護於患者返家後之持續性照護，減少行動不便患者舟車勞頓之醫院回診，降低醫療支出。

Diabetes affects approximately 589 million people worldwide and foot ulcers are among the most common complications. Poor wound care and recurrent infections often lead to amputation and mortality. Therefore, proper glycemic control, close wound monitoring, and effective follow-up are crucial. In recent years, telemedicine has increasingly been applied in the management of patients with diabetic foot ulcers. However, its clinical effectiveness remains uncertain. This study aimed to evaluate the effects of telemedicine on wound healing time, amputation rate, and mortality in patients with diabetic foot ulcers. Chinese and English keywords based on the PICO framework were used, with P defined as patients with diabetic foot ulcers, I as telemedicine, C as outpatient department treatment, and O as wound healing, amputation rate, and mortality. Five electronic databases, namely PubMed, Embase, the Cochrane Library, Airiti Library, and the China National Knowledge Infrastructure (CNKI), were searched for studies published between 1947 and 2025. Study selection followed the PRISMA 2020 flow diagram. Study quality was assessed using the RoB 2.0 tool, the Modified Jadad Scale, and the ROBINS-I V2 tool. Meta-analysis was performed using Comprehensive Meta- Analysis Version 3.0. A total of 66 articles were identified. After rigorous screening, five randomized controlled trials (n=1,225) and three quasi-experimental studies (n=1,085) involving patients with diabetic foot ulcers were included. The meta-analysis showed that telemedicine significantly reduced the risk of amputation (OR=0.649; 95％CI=0.457- 0.920; p<0.02). However, no significant differences were observed in wound healing time and rate and 12-month mortality (p>0.05). Telemedicine was associated with a lower amputation rate in patients with diabetic foot ulcers, whereas outcomes for wound healing time and rate and 12-month mortality were comparable to those of conventional outpatient care. These findings support the appropriate use of telemedicine for post-discharge continuity of care to reduce hospital visits among patients with limited mobility and to lower overall healthcare costs.