The effect of text message support on diabetes self-management in developing countries - A randomised trial

Area of Science:

• Global Health
• Digital Health
• Diabetes Management

Background:

• Mobile health (mHealth) interventions show promise for enhancing self-management among individuals with chronic conditions.
• This study investigated the efficacy of a mobile phone-based intervention within established diabetes programs in low- and middle-income countries.

Purpose of the Study:

• To evaluate the impact of a text message-based self-management support intervention on diabetes control.
• To assess the effectiveness of a standardized mHealth intervention across diverse healthcare contexts in the Democratic Republic of Congo, Cambodia, and the Philippines.

Main Methods:

• A randomized controlled trial design was employed across three countries, involving 480 adults with diabetes in each sub-study.
• Participants were randomized to receive either routine care or routine care supplemented with text message support.
• The primary outcome measured was the proportion of participants achieving well-controlled diabetes (HbA1c levels) after a 2-year follow-up period.

Main Results:

• A total of 781 participants had available HbA1c measurements at baseline and 2 years.
• The intervention group showed a 2.8% higher proportion of controlled HbA1c compared to the control group, a difference that was not statistically significant.
• Logistic regression analysis indicated an odds ratio of 1.1 for controlled diabetes post-intervention, after adjusting for key covariates. HbA1c trends varied by country, with improvements in DR Congo and declines in Cambodia.

Conclusions:

• This trial represents the first comparative assessment of the same mHealth intervention across multiple countries.
• The results suggest that mHealth interventions, specifically text messages, may not provide an additional benefit for diabetes control in these settings.
• Factors such as program coverage, routine care quality, and disease progression can influence the effectiveness of mHealth initiatives.