title: Health education via mobile text messaging for glycemic control in adults with type 2 diabetes: a systematic review and meta-analysis.
abstract: BACKGROUND
  Diabetes type 2 is an increasing problem worldwide that may be managed through education. Text-messaging using a cell phone can assist with self-care. The aim of this study was to systematically review the impact of education through mobile text-messaging on glycemic control.
  
  
  METHODS
  The design was a systematic review with meta-analysis. Five electronic databases were searched to access English studies involving a randomized controlled trial design that used text-messaging educational interventions in patients with type 2 diabetes during an 11-year period (2003-2013). Studies were evaluated using a quality assessment scale adapted from Jadad scale and Cochrane handbook. Extraction of data was carried out by two reviewers. A random-effect model with a standardized mean difference and Hedges's g indices was used for conducting the meta-analysis. Subgroup analyses were conducted and a Funnel plot was used to examine publication bias.
  
  
  RESULTS
  Ten studies overall were identified that fulfilled inclusion criteria, involving a total of 960 participants. The mean age of the sample was 52.8 years and majority were females. Data were heterogeneous (I(2)=67.6). Analyses suggested a publication bias based on Egger's regression (P<0.05). HbA1c was reduced significantly in experimental groups compared to control groups (P<0.001). The effect size for glycemic control in studies that used text-messaging only was 44%. For studies that used both text-messaging and Internet, the effect size was 86%.
  
  
  CONCLUSIONS
  Mobile text-messaging for educating Type 2 diabetics appears to be effective on glycemic control. Further investigations on mobile applications to achieve educational goals involving other diseases are recommended.
authors.affiliation: Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran; Health Education Department, School of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran. Electronic address: m.saffari@bmsu.ac.ir.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Saffari
authors.affiliation: Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Electronic address: Qanizadeh@yahoo.com.
authors.forename: Ghader
authors.initials: G
authors.lastname: Ghanizadeh
authors.affiliation: Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; King Abdulaziz University, Jeddah, Saudi Arabia. Electronic address: Harold.Koenig@duke.edu.
authors.forename: Harold G
authors.initials: HG
authors.lastname: Koenig
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D040421:Cell Phone; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D017010:Reminder Systems; D060145:Text Messaging
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Health education; Short message service; Systematic review; Type 2 diabetes