Background: Around 463 million people globally have diabetes of which over 90% have type 2 diabetes (T2D). Projections indicate an expected increase to 700 million by 2045. The COVID-19 pandemic accelerated digital health uptake, establishing virtual consultations as a feasible alternative to traditional in-person care. Despite promising preliminary evidence, a comprehensive review is needed to fully assess the impact of virtual consultations on diabetes care. This review aims to systematically evaluate the impact of remote consultations on the quality of care provided to persons with T2D, by mapping impacts against the six quality domains outlined by the National Academy of Medicine (NAM) (i.e., patient-centeredness, effectiveness, efficiency, timeliness, equity, and safety).
Methods and analysis: PubMed/MEDLINE, COCHRANE, EMBASE, CINAHL, and Web of Science will be searched for studies published between 2010 and 2024. Primary outcomes will include any quality measures pertaining to the NAM domains for adult patients accessing virtual consultations. The Cochrane Collaboration's tool will be used to assess the quality of the randomised studies and Risk of Bias in Non-Randomised Studies – of Interventions (ROBINS-I) will be used for non-randomised studies. The findings will be summarised as a narrative synthesis. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 15 November 2023 (registration number: CRD42023474219)
Ethics and dissemination: This review will not include primary data and therefore does not require ethical approval. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. Findings will be disseminated as academic publications and conference presentations and summarised into patient-led lay summaries.






STRENGTHS AND LIMITATIONS OF THIS STUDY:
 Comprehensive inclusion criteria will encompass a variety of study designs, including randomised controlled trials, cluster randomised trials, quasi-experimental studies, case-control and cohort studies, cross-sectional analyses, and cost-effectiveness studies, covering both primary and secondary care settings.
 The use of National Academy of Medicine (NAM)’s six domains of quality care offers a robust rationale for a comprehensive assessment of virtual care. An in-depth examination of the quality dimensions of virtual consultations (i.e. telephone and video), ensures a holistic analysis of their implications on the quality of care delivered.
 The inclusion of diverse study designs may lead to heterogeneity in results, thus posing challenges to their synthesis.