title: Mobile phone intervention to improve diabetes care in rural areas of Pakistan: a randomized controlled trial.
abstract: OBJECTIVE
  To determine the effect of mobile phone intervention on HbA1c in type-2 Diabetes Mellitus (DM) patients living in rural areas of Pakistan.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Department of Endocrinology, Liaquat National Hospital, Karachi, from December 2013 to June 2014.
  
  
  METHODS
  A total of 440 patients in intervention and control groups were enrolled. All patients between 18 - 70 years of age, residing in rural areas of Pakistan, HbA1c ³ 8.0% and having personal functional mobile phone were included. The intervention group patients were called directly on mobile phone after every 15 days for a period of 4 months. They were asked about the self-monitoring blood glucose, intake of medications, physical activity, healthy eating and were physically examined after 4 months. However, the control group was examined initially and after 4 months physically in the clinic and there were no mobile phone contacts with these patients.
  
  
  RESULTS
  Patients in intervention group showed improvement (p < 0.001) in following diet plan from 17.3% at baseline to 43.6% at endline, however, the control group showed insignificant increase (p=0.522) from 13.6% at baseline to 15.9% at endline. Intervention group (RR = 2.71, 95% CI = 1.18 - 6.40) showed significant positive association with normalization of HbA1c levels. The relationship was adjusted for age, gender, socio-economic status, ethnicity, education, hypertension, medication, BMI, diet, LDL levels and physical activity. Dietary restriction and low LDL levels also showed significant associations with reduced HbA1c levels on multivariate analysis.
  
  
  CONCLUSIONS
  Mobile phone technology in rural areas of Pakistan was helpful in lowering HbA1c levels in intervention group through direct communication with the diabetic patients. Lowering LDL and following diabetic diet plan can reduce HbA1c in these patients and help in preventing future complications.
authors.affiliation: Department of Endocrinology, Liaquat National Hospital (LNH), Karachi.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Shahid
authors.affiliation: Department of Endocrinology, Liaquat National Hospital (LNH), Karachi.
authors.forename: Saeed Ahmed
authors.initials: SA
authors.lastname: Mahar
authors.affiliation: Department of Community Medicine, Liaquat National Hospital (LNH), Karachi.
authors.forename: Shiraz
authors.initials: S
authors.lastname: Shaikh
authors.affiliation: Department of Medicine, Liaquat National Hospital (LNH), Karachi.
authors.forename: Zuhaib-u-ddin
authors.initials: ZU
authors.lastname: Shaikh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D040421:Cell Phone; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004032:Diet; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006973:Hypertension; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010154:Pakistan; D019035:Rural Health Services; D012424:Rural Population; D012648:Self Care; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents