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

Abstract Background 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 reminders vs. those provided standard care Methods 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. Results Mean age of participants in the intervention arm and the control arm was 49.7 (SD =9.94) and 51.3 (SD 9.79) years respectively. 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. Odds ratio and confidence interval for the intervention was 1.04(0.96 – 1.14) compared to the control arm. However, diet quality score of overweight participants was 17% (OR: 0.83 CI: 0.70-0.99) less than that of normal weight participants. Each additional score points at baseline resulted in an almost 20% (OR: 1.20 CI: 1.07-1.34) increase in the adherence score at follow-up. Conclusion Findings of the study suggest that there is no effect of dietary text message reminders on the dietary adherence of patients with Type II diabetes in a three months duration study. However, adherence to a healthy diet is better in patients who had a healthy diet to begin with and those who were obese. Trial Approval and Registration Approval for this study was obtained from the Ethical Review Committee (ERC NO: 1981-CHS-ERC-11) of the Aga Khan University Hospital. This trial was registered on “Australian New Zealand Clinical Trials Registry”. Trial registration number is: “ACTRN: ACTRN12612000538842”