We aimed to access whether mobile phone SMS interventions would help to prevent the risk factors for cardiovascular diseases in patients with type 2 diabetes in Bangladesh.Design and method:
We conducted a prospective randomized clinical trial of type 2 diabetes patients attending a tertiary hospital in Dhaka, Bangladesh from September 2013 to June 2014. Patients were randomized (1:1) by simple randomization to a mobile phone (SMS) intervention or standard of care. Patients in the intervention group received daily SMS messages. We used mixed-linear regression analysis to estimate marginal means and difference in mean change at the end of 6 months as effects of SMS intervention.Results:
We randomly assigned 236 participants to the SMS intervention (n = 118) or to standard case (n = 118). In the SMS group, HbA1c declined from 8.12 ± 1.67 % at baseline to 7.38 ± 1.05 % at 6 months with difference in mean change −0.741 (95% CI −1.10, −0.38; p = 0.000). A similar reduction occurred in the control group (8.49 ± 1.94% to 8.07 ± 1.51%) with difference in mean of −0.42 (95% CI −0.87, 0.03; p = 0.064). The model-adjusted intervention effect of SMS intervention (calculated as difference-in-difference) of −0.32 (95% CI −0.89, 0.25; p = 0.272) indicated that mobile phone SMS was superior to standard-of-care alone in reducing HbA1c. Similar findings were observed in the complete-case analyses, where the difference in mean changes in the SMS group between baseline and 6 months were −0.79 (95% CI −1.17, −0.42; p = 0.064). However, the difference-in-difference calculated as an effect of the SMS intervention in complete case analysis was only −0.55 (95% CI −1.14, 0.04; p = 0.067). Similar changes were reported for physical activity, smoking and diet.Conclusions:
Mobile phone SMS might be effective tools to improve patient outcomes for prevention of cardiovascular risk factors in Bangladesh and other developing countries.