Assessment of Dietary Compliance among Patients with Type 2 Diabetes Mellitus Receiving Text Message (SMS) Reminders: A Randomized Control Trial

INTRODUCTION: Compliance to a healthy diet is very important for effective management of type 2 DM. Use of electronic devices in the field of health care has been successful in motivating patients to improve their health behaviors. Studies have proved that by motivating patients with reminders through short message service, compliance to healthy diet can be improved which can lead to better diabetes control. However such studies have not been conducted in Pakistan. Objective of this study is, “to assess the difference in dietary compliance in patients with type-II diabetes, reminded through mobile text messages vs. those provided standard care”.

METHODS: A block RCT is being conducted at Aga Khan University in Karachi, Pakistan. Diabetic patients age 30 to 70 years, who have been diagnosed and confirmed as a known cases of type 2 DM in the last 2 to 15 years are being invited to participate in the study. In the intervention arm three text message reminders are being sent per week using Frontline SMS software for 3 months. Compliance to diet is being measured by assigning score to the dietary intake assessed by Food Frequency Questionnaire (FFQ). Interim analysis was conducted after follow-up of 1.5 months on 60 participants. 

RESULTS: We did not observe any difference in dietary compliance in the two arms of the study (F _(group) = 0.065; p-value= 0.790) as well as within the arms (F _(time) = 0; p-value>0.990). Marginal interaction was observed between group variable and factor variable (F _{(interaction)} = 3.702; p-value= 0.059).  

CONCLUSIONS: Findings of the interim analysis suggest that there is no effect of text messages (short message service) on dietary compliance of diabetic patients. We are unable to make conclusion about the relationship of dietary text message reminders and dietary compliance in type 2 diabetic patients with the available data. The reason might be the time period to observe the behavioral change is short.