SMS-based intervention in type 2 diabetes: clinical trial in Senegal

Objective Since 2014 Senegal has benefited from regular awareness-raising Short Message Service (SMS) campaigns (Be He@lthy, Be Mobile initiative) directed at people who have signed up, for free, to the ‘mDiabète’ programme. We report on an evaluation of its impact on diabetes control. Design The clinical trial was designed to send daily SMS during 3 months to people with type 2 diabetes. Due to centre randomisation, SMS were sent from inclusion (M0) to month 3 (M3) to people in centre S and from M3 to month 6 (M6) to people in centre P. Setting Medical centre S in the northwestern suburbs of Dakar; centre P in Popenguine, 70 km south of Dakar. Participants In February 2017, people with type 2 diabetes were consecutively recruited in the two centres. Complete data were available from 186 of these people. Main outcome measures HbA1c was measured in the two centres with the same assay throughout the study. The primary end point was the difference between centres for the change in HbA1c from M0 to M3. Secondary end points were the evolution of HbA1c in centres S and P between M3 and M6. Results The HbA1c change from M0 to M3 in centre S was better than in centre P, with a median difference of −0.4%, quartiles (−1.0; 0.3) versus 0.2% (-0.5; 0.8), respectively (p=0.0038). HbA1c decreased over the 3 months after having stopped SMS in centre S and was confirmed in centre P. The campaign cost was €2.5 (US$3.1) per person. Conclusions In Senegal, SMS sending was associated with an improved glycaemic control in people with type 2 diabetes. As SMS has a high penetration in low-income, middle-income countries where medical resources are scarce, health interventions using mobile telephones should be developed to facilitate exchanges between people with diabetes and medical teams; this may reduce diabetes-related complications.