Abstract
To evaluate the effectiveness of telemedicine for cardiometabolic disease control in Latin America and the Caribbean (LAC). We systematically searched international and regional databases from inception to 17 December 2025 for telemedicine interventions in adults with type 2 diabetes, hypertension, or dyslipidaemia in LAC. Risk of bias and certainty of evidence were assessed using validated tools and GRADE, respectively. Random-effects meta-analyses included clinically comparable randomised trials. Twenty-two studies from 10 countries were included (11 randomised). Meta-analyses included seven trials (935 participants) for HbA1c, four (451) for systolic blood pressure, and three (280) for diastolic blood pressure. Pooled estimates favoured telemedicine for HbA1c (MD -0.62%, 95% CI -1.02, -0.22; low certainty), systolic blood pressure (MD -6.60 mmHg, 95% CI -9.49, -3.71; high certainty), and diastolic blood pressure (MD -4.25 mmHg, 95% CI -6.53, -1.98; moderate certainty). HbA1c heterogeneity was substantial (I2 = 66%), and its prediction interval crossed the null (-1.77%, 0.56%). Selected telemedicine interventions may improve intermediate cardiometabolic outcomes in specific LAC settings. However, limited and heterogeneous evidence, variable certainty, and insufficient evidence on long-term effectiveness, scalability, cost-effectiveness, and equity preclude broad implementation recommendations. CRD420251234521.