OBJECTIVES: To analyze the effect of mobile phone text-messaging on diabetes management and assess the cost-effectiveness of the intervention in patients with type 2 diabetes.

METHODS: We conducted a prospective, parallel-group, randomized, controlled clinical trial at a tertiary hosptial in Bangladesh. Patients with type 2 diabetes were randomized (1:1) to a text-messaging intervention plus standard-care or standard-care alone. Patients in the intervention group received daily text-messaging for 6 months encouraging treatment adherence and healthy lifestyles. Clinical endpoints were assessed with standarized methods, and patient self-management was assessed via questionnaires. Multivariate linear, logistic, and Poisson regression models, adjusted for age, sex, and baselines values, were applied following an intention-to-treat approach. The economic evaluation was conducted from a health services perspective. Costs for the intervention were estimated from internal accounting, and incremental cost-effectiveness ratios were expressed as cost per 1% unit reduction in HbA1c and per gain in quality-adjusted life years (QALYs).

RESULTS: We assessed 515 patients for eligibility. A total of 236 patients (mean age 48 years) were randomized to either the intervention (n=118) or standard-care (n=118). At the 6-month follow-up, the intervention group had a statistically significantly lower HbA1c (–0.64%, 95%CI: –0.95; –0.33), but the groups did not differ in clinical (blood pressure, cholesterol), anthopometric, or behavioral outcomes. The adjusted difference in accumulated QALYs between the intervention and the control group over the 6-month period was 0.010 (95%CI: 0.000; 0.021). Incremental costs per patient averaged 24 international dollars (Intl.$), resulting in incremental cost-effectiveness ratios of 38 Intl.$ per % HbA1c reduction and 2,406 Intl.$ per QALY gained.

CONCLUSIONS: The mobile phone text-messaging improved glycemic control, but not other clinical outcomes or patient self-management. Text-messaging might be a valuable addition to standard treatment for patient with diabetes in low-resource settings, but studies with longer follow-up and larger samples are needed.