Assessment of Dietary Compliance among Patients with Type II Diabetes Mellitus Receiving Text Message (SMS) Reminders for improving adherence to healthy diet in Pakistan: A Randomized Control Trial

Summary Results: Motivating patients through text message (SMS) reminders can improve adherence to a healthy diet and can lead to better diabetes control. This study was carried out to assess the difference in dietary adherence in patients with Type II diabetes, who were sent dietary text message A block randomized control trial was conducted at the Aga Khan University Hospital in Karachi, Pakistan. Patients (n=249), diagnosed with Type II diabetes were invited to participate in the study. At baseline, dietary guidelines were provided to all the study participants. In the intervention arm, three dietary text message reminders were sent per week for 3 months. Adherence to diet was measured by assigning a score to the dietary intake assessed by the Food Frequency Questionnaire (FFQ) both at baseline and after follow-up. The results of the study showed no change in diet quality score from baseline till 3 months of the follow up in the intervention arm compared to the control arm. However, diet quality score of overweight participants was less than that of normal weight participants. Each additional score points at baseline resulted in an almost 20% increase in the adherence score at follow-up. We were unable to assess the compliance to text message reminder, there could be a possibility of ignorance of text message reminders in this population. Also, the follow-up duration was very small to asses a behavioral change effect. This is the first epidemiological study to assess dietary adherence in people with diabetes by sending dietary text message reminders in Pakistan. It can have important public health implications especially in low- and middle-income countries as it has the potential of lowering the use of healthcare resources while reaching out to a larger audience, and thereby improving health care delivery. Moreover, on a larger scale, more effective communication with patients can be achieved by text message interventions if messages are personalized and interactive, as it can improve health care delivery. Along with the work of primary health care providers, mobile health technology can work in conjunction with practices already in place to improve effective patient-provider communication, adherence to treatment and self-management ability