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To analyze the effect of mobile phone text messaging intervention for reducing cardiovascular risks in patients with type 2 diabetes.Prospective, parallel-group, randomized, controlled clinical trial at a tertiary hosptial in Bangladesh. Patients with type 2 diabetes were randomized (1:1) to a text messaging intervention plus standard care or standard care alone. Multivariate linear, logistic, and Poisson regression models, adjusted for age, sex, and baselines values, were applied following an intention-to-treat approach. The economic evaluation was conducted from a health services perspective. Costs for the intervention were estimated from internal accounting, and incremental cost-effectiveness ratios were expressed as cost per 1% unit reduction in HbA1c and per gain in quality-adjusted life years (QALYs).Of 515, 236 patients with a mean age of 48 years were eligible and randomized to either the intervention (n = 118) or standard-care (n = 118). At the 6-month follow-up, the intervention group had a statistically significantly lower HbA1c (–0.64%, 95%CI: –0.95; –0.33), but the groups did not differ in blood pressure, cholesterol, anthopometric, or behavioral outcomes. The adjusted difference in accumulated QALYs between the intervention and the control group over the 6-month period was 0.010 (95%CI: 0.000; 0.021). Incremental costs per patient averaged 24 Intl.$, resulting in incremental cost-effectiveness ratios of 38 Intl.$ per % HbA1c reduction and 2,406 Intl.$ per QALY gained.The mobile phone text messaging improved glycemic control, but not other risk factors. Text messaging is low-cost and might be a valuable addition to standard treatment for cardiovascular risk reduction in patient with diabetes in low-resource settings, but further studies are warranted.