Growing evidence suggests that utilizing mobile phones might improve diabetes self-management and clinical outcomes (6-10). A meta-analysis examined the effectiveness of mobile phone technology in diabetes mellitus care by reviewing 15 English-language articles, published between January 2002 and March 2012. Studies that used mobile phone intervention and reported changes in diet, physical activity, and blood glucose and/or HbA1c levels were retrieved. Overall, significant improvements were observed in blood glucose and/or HbA1c concentration, adherence to medication, healthy lifestyle, and self-efficacy (11). These studies took place in several countries including the United States. Our Study is probably among the first ones to be conducted in the Arab peninsula where diabetes prevalence is very high. In our study, the change in post prandial blood sugar was remarkable, which significantly decreased the level of HbA1c.
Holtz et al. identified peer-reviewed articles published between 2000 and 2010 and analyzed 21 articles in a systematic literature review. Overall, 71% of the studies had used a study-specific application, which had supplemental features in addition to text messaging. The outcomes varied considerably across studies, but some positive trends such as improved self-efficacy, HbA1C, and self-management behaviors were noted (12). In our cohort, SMS positively modified patients’ behavior. Although the frequency of blood glucose monitoring was not increased significantly, the rate of glycemic control was improved.
A feasibility study was conducted to evaluate the utility of SMS in supporting 42 Iraqi adults with newly diagnosed type 2 diabetes over 29 weeks. HbA1c decreased from 9.3% (SD, 1.3%) to 8.6% (SD, 1.2) (P = 0.001). Mean knowledge score rose from 8.6 (SD, 1.5) at baseline to 9.9 (SD, 1.4) six months after receipt of SMS (P = 0.002). All patients were satisfied with the text messages and wished the service to be continued after the study (13). Our study demonstrated similar benefits of this technology on diabetes education and management.
The effect of distance education via mobile phone text messaging on knowledge, attitude, practice, and self-efficacy was evaluated in patients with type 2 diabetes mellitus in Iran. The results in the experimental group showed significant improvement in HbA1c (P = 0.024), low density lipoprotein (P = 0.019), cholesterol (P = 0.002), and micro albumin (P ≤ 0.001). The knowledge (P ≤ 0.001), practice (P ≤ 0.001), and self-efficacy (P ≤ 0.001) were also improved (14).
In a randomized study in India, the acceptability and feasibility of using SMS via cell phones to ensure adherence to management prescriptions was tested. Medications adherence improved and positively affected HbA1c and plasma lipids levels (15). We did not test medications adherence in our study; however, the patients admitted that their compliance with drug intake was better. A one-way video message about diabetes self-care was sent to 65 patients with type 2 diabetes for one year. Participants were randomized to receive the usual care or the self-care video messages from their diabetes nurse practitioner. Participants who received the messages had a larger rate of decline in HbA1c than people who received usual care had (0.2% difference over 12 months) (16). We believe that multimedia message service might have a better audiovisual effect in comparison to regular SMS; however, it should be tested in further studies.
Mobile phone text educational and interactive messaging service might provide benefit in supporting diabetes self-management. The results of this study might help to design future text message interventional support programs for other chronic illnesses.
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