1. Assessment of dietary compliance among patients with type ii diabetes mellitus receiving text message (sms) reminder: a randomized control trial
Gulshan Bano Ali
Senior Instructor (Research)
Surgery, Aga Khan University
Supervisor: Dr. Romaina Iqbal
Committee Members: Mr. Iqbal Azam
Dr. Shariq Khoja
Dr. Javed Akhtar 1 1

2. Background, Rationale, Objective
Physical activity
Insulin
Oral Medication
Diet
According to WHO estimates 285 million individuals are suffering from Diabetes Mellitus (DM) (WHO. 2011)
2010 to 2030, there would be 69% and 20% increase in the number of cases of DM in developing and developed countries respectively (Shaw JE.et al.2009)
Prevalence in Pakistan is 7.6% (IDF, Diabetes Atlas Fifth Edition.2010)
Objectives:
To assess the difference in dietary compliance in patients with type 2 DM, who were reminded through text messages (SMS) vs. those not reminded”
To assess dietary compliance by using responses to fortnightly two-item questionnaire for the intake of fruits and vegetables in the last 24 hours
To assess the change in HbA1c level of participants in both the groups.
As we all know there are four major components of diabetes management i.e. diet, physical activity, oral medication and insulin. While I would like emphasize over here that it is very important to know that management with diet is central to all.

3. All the participants with type 2 Diabetes Mellitus coming to AKUH, Karachi n=6256
Methodology
Not Meeting Inclusion Criteria (n=5145)
Refusals (n=862)
Enrolment
Recruited sample of
eligible participants n = 249
Baseline assessment
Dietary guidelines with detailed
counseling
Block Randomization
Allocation
Intervention Group (n = 126)
Text message reminder
Fortnightly two-item questionnaire
Control Group (n = 123)
Fortnightly two-item questionnaire
Follow up of 3 months
Analysis
Assessment of outcome (dietary compliance score) n=124
Assessment of outcome (dietary compliance score) n=123

4. Table 1: Distribution of baseline characteristic in control and intervention arm
Variables
Control
n=123
Intervention
n=126
Gender n(%)
Male
72 (47.68)
79 (52.32)
Female
51 (52.04)
47 (47.96)
Education n(%)
Can’t read & write
10 (62.5)
6 (37.5)
Primary/ Middle
9 (37.5)
15 (62.5)
Secondary/ Higher sec
39 (50.0)
39 (50.0)
Graduation/Post Grad
65 (49.6)
66 (50.4)
Depression n(%)
Normal
61 (48.0)
66 (52.0)
Depressed
5 (41.8)
7 (58.3)
Anxious
38 (50.7)
37 (49.4)
Anxious and Depressed
19 (54.3)
16 (45.7)
Compliance score at baseline (mean + sd)
Social support score (mean + sd)
Age (mean + sd)
House hold income (median, IQR)
50K ( K)
Waist Hip ratio (mean + sd)
Years with Diabetes (mean + sd)

5. Table 2 : Effect of intervention on dietary compliance assessed by FFQ
Un-adjusted
Adjusted
Variables
Coefficient
P- value
[95% Conf. Interval]
p- Value
LCI
UCI
Group (Intervention)
-0.021
0.643
-0.11
0.07
-0.037
0.364
-0.12
0.04
Baseline Compliance score
0.299
0.009
0.08
0.52
0.309
0.003
0.11
0.51
Gender (Female)
-0.092
0.054
-0.19
0.00
-0.103
0.018
-0.02
Body mass Index
Normal
0.833
<0.001
0.66
1.01
0.896
0.71
1.08
Overweight
0.840
0.74
0.94
0.906
0.81
1.00
Obese
0.914
0.87
0.96
1.024
1.09

6. Table 2 : Effect of intervention on dietary compliance assessed by Fortnightly SMS
Un-adjusted
Adjusted
Variables
Coefficient
P- value
[95% Conf. Interval]
p- Value
LCI
UCI
Group (Intervention)
-0.047
0.734
-0.32
0.23
-0.07
0.60
-0.35
0.20
Gender (Female)
-0.186
0.18
-0.46
0.08
-0.19
0.206
-0.47
0.10
Edu_cat
Primary/Middle
0.479
0.091
-0.08
1.03
0.47
0.103
-0.10
1.05
Secondary/Higher
0.437
0.067
-0.30
0.91
0.40
0.102
0.88
Graduation/Post Grad
0.406
-0.03
0.84
0.32
0.177
-0.14
0.78
Age
-0.006
0.250
-0.02
0.01
-0.01
0.455

7. Table 2 : Effect of intervention on HbA1c level recorded from medical records
Un-adjusted
Adjusted
Variables
Coefficient
P- value
[95% Conf. Interval]
p- Value
LCI
UCI
Group (Intervention)
-0.335
0.118
-0.75
0.08
-0.375
0.090
-0.809
0.060
Gender (Female)
-0.655
0.259
-0.92
1.49
-0.406
0.091
-0.878
0.065
Body mass Index
Normal
-0.66
0.004
-1.11
-0.21
-0.550
0.016
-0.997
-0.103
Overweight
-0.923
<0.001
-1.26
-0.58
-0.849
0.005
-1.439
-0.259
Obese
-0.770
-1.06
-0.47
-0.607
0.015
-1.095
-0.120
Anxiety_depression
Depressed
1.148
0.006
0.33
1.96
1.226
0.003
0.413
2.040
Anxious
0.210
0.350
-0.23
0.65
0.267
0.271
-0.211
0.745
Anxious and Depressed
0.526
0.112
-0.12
1.17
0.642
0.057
-0.018
1.303

8. Conclusion
We are unable to find any significant difference in the dietary compliance in type 2 diabetic patients in two study arms
These findings suggest that there is no effect of text messages on dietary compliance of type 2 diabetic patients
The reasons might be short follow up time for a behavioral change intervention, or it could be because of ignorance of the patients.