Short Message Service for Type 2 Diabetes
Condition: Diabetes Mellitus, Type 2
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      Diabetes is a chronic disease where type 1 diabetes (T1D) is due to autoimmune ẞ-cell
      destruction, usually leading to absolute insulin deficiency, type 2 diabetes (T2D) is due to
      a progressive loss of ẞ-cell insulin secretion frequently on the background of insulin
      resistance. A third type-Gestational diabetes mellitus (GDM)-is diagnosed in the second or
      third trimester of pregnancy and was not clearly overt diabetes prior to gestation (American
      Diabetes Association. Lifestyle management can enhance diabetes care and it includes diabetes
      self-management education and support (DSMES), medical nutrition therapy, physical activity,
      smoking cessation counselling, and psychosocial care. However, health systems cannot control
      all the factors that influence a person's overall health, as physicians are unable to check
      regularly what their patients eat or whether they properly adhere to their medications.
      Pharmacists involved in DSMES can help patients achieve therapeutic and lifestyle goals. This
      active participation requires that the pharmacist's practice extend beyond the traditional
      role. Patients and care providers should work together to optimize lifestyle aspects through
      the entire care process. Telemedicine "healing at a distance" signifies the use of
      information and communication technology to improve patient outcomes by increasing access to
      care and medical information. Using mobile and wireless technologies to achieve health
      objectives (mHealth) can universally transform health services' delivery. Mobile phones can
      easily reach population since they have exceeded other communication technologies in Low and
      middle-Income countries (LMICs). The results of the present study will help the policy-makers
      in the MOHP to understand the importance of creating healthcare systems that meet the needs
      of patients and providers and develop DSMES strategy with the help of pharmacist educator and
      using innovative mobile phone technology.
    

Detailed description: 
      The global prevalence of diabetes among adults aged over 18 years old has increased from 4.7%
      in 1980 to 8.5% in 2014 (Mathers & Loncar, 2006; WHO, 2018b). The World Health Organization
      (WHO) estimates that diabetes was the seventh leading cause of death in 2016 (WHO, 2016; WHO,
      2018a). Current national statistics show that around 17% of all Egyptian adults have
      diabetes, and over 60% of diabetics receive no treatment (Eastern Mediterranean Regional
      Office (EMRO), 2016). According to the WHO, there will be 6,726,000 cases of diabetes in
      Egypt by 2030 (WHO, 2000).

      Almost 45% of patients with T2D cannot achieve adequate glycemic control (HbA1c <7%). Poor
      medication adherence in T2D is a common public health problem and is associated with poor
      glycemic control, increased morbidity and mortality, and increased costs of outpatient care,
      emergency room visits, hospitalization, and managing complications of diabetes (Polonsky &
      Henry, 2016).

      Pharmacists involved in DSMES can help patients achieve therapeutic and lifestyle goals. This
      active participation requires that the pharmacist's practice extend beyond the traditional
      role (Shane-McWhorter et al., 2009). Patients and care providers should work together to
      optimize lifestyle aspects through the entire care process (Abaza & Marschollek, 2017).

      In Egypt, the Ministry of Health and Population (MOHP) is partially implementing diabetes
      education, mostly in outpatient clinics via educational meetings or counselling with
      physicians/ nurses. Patients often report difficulty sticking to healthy lifestyles. They are
      also liable to forget or ignore their physician's advice after leaving the clinic. Therefore,
      they need an educational method that can easily reach them to make knowledgeable patients and
      save the physician's critical time (Abaza & Marschollek, 2017).

      According to the Ministry of Communications and Information Technology (MCIT) in Egypt, up to
      October 2019, there were 95.25 million mobile subscriptions as opposed to 8.72 million
      fixed-line subscriptions (Ministry of Communication and Information Technology [MCIT], 2019).
      Moreover, there were 38.67 million mobile internet users versus 7.17 million Asymmetric
      Digital Subscriber Line subscriptions in the same month; the mobile internet users could
      reflect the proportion of smartphone owners in the country (MCIT, 2019). In contrary to
      mobile internet or smartphone applications, short message service (SMS) can provide a simple
      way of communication reaching a larger population since almost all types of mobile phones
      support them (Abaza & Marschollek, 2017).
    

Intervention name(s): Mobile Phone Short Message Service
Intervention type(s): Behavioral
Intervention description(s): SMS content will be adopted from the validated Arabic national and international diabetes educational materials (Centers for Disease Control (CDC), 2018; Diabetes Australia, 2004; Diabetes Queensland, 2012; Utah Diabetes Control Program, 2005).
The mobile phone SMSs will be pre-tested for clarity on a sample of 10 patients similar to the study population and their comments on the SMSs wording will be used to modify them to ensure acceptance.
The SMS will be sent to participants using the internet, open-source software for bulk messages and a local telephone network provider.
Patients will be encouraged to send messages/call the researcher for any queries encountered.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Quasi-experimental; non-randomized, pre-test, post-test control group design.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Diabetes; Medication adherence; Telemedicine; mhealth; SMS