Remote Endocrinology Support for Primary Care Clinicians Managing Type 2 Diabetes: A Systematic Review of Randomized Controlled Trials

Remote endocrinology support may strengthen diabetes management in primary care, but the clinical effectiveness of clinician-directed models remains uncertain.This systematic review evaluated randomized trials of structured remote endocrinology support for primary care clinicians managing adults with type 2 diabetes.PubMed/MEDLINE, Europe PMC, and ClinicalTrials.govwere searched through September 29, 2026, supplemented by citation searching.Eligible interventions included electronic consultations, videobased case conferencing, and specialist-led telementoring.Findings were synthesized narratively because of clinical and methodological heterogeneity.Five cluster-randomized trials, including one modified steppedwedge trial, met eligibility criteria.The clearest favorable findings concerned prescribing: in one trial, guideline-concordant glucagon-like peptide 1 receptor agonist and/or sodium-glucose cotransporter 2 inhibitor use was higher in eligible patients with ischemic heart disease (65.2% vs. 47.6%;difference, 17.6 percentage points; 95% CI, 4.6 to 30.7), whereas glycated hemoglobin target attainment was similar (83.2% vs. 80.9%; p = 0.28).Another trial reported greater prescribing increases in a post-randomization matchedcohort analysis (19.3 vs. 6.9 percentage points).Across trials, comparative glycemic and cardiometabolic outcomes showed no consistent improvement.Favorable glycemic findings from telementoring relied on pre-post comparisons rather than randomized treatment-effect estimates.Specialist recommendation uptake was incomplete.Among four results assessed with Risk of Bias 2, three raised some concerns, and one was at high risk of bias; safety reporting was limited.Remote endocrinology support may improve selected prescribing practices, but its effects on clinical outcomes remain uncertain.Larger, rigorous randomized trials evaluating clinical outcomes, implementation, and safety are needed.