A Randomized Trial Using Mobile Short-Text Messaging to Improve Cardiovascular Risk Profile in Poorly Controlled Diabetes in Kenya

Introduction: Cardiovascular disease (CVD) is a major cause of death in the diabetic population. Prevention strategies that target high-risk individuals are the most effective means of preventing adverse events. Mobile telephony is widely accessible in Kenya with a penetration of 90.4% (2017). This offers new opportunities such as the utilization of m-Health technologies in healthcare. The primary objective of this study was to determine the impact of a lifestyle information, motivation and support sent via mobile phone text messages on glycemic control and other established risk factors for CVD, in a population with poorly controlled diabetes in Kenya. Methods: Between May 2016 and October 2017 patients with Type 2 diabetes and HbA1c \u3e7.0% were prospectively randomized to either standard care, or standard care plus text message life style intervention. Key data collected at baseline and at 6 months were: HbA1c, BMI, waist circumference, blood pressure and lipid profile. Results: A total of 240 patients (54.5% male) underwent blind randomization. Of these 40 were lost to follow up (16.7%). The mean age at inclusion was 51.3±10.4 years, and the mean BMI 28.9±5.3 kg/m2. HbA1c at baseline was 9.61±2.5% and 9.5±1.9% in the control and intervention groups respectively, p=0.92. At 6 months the relative decline in HbA1c in the control and intervention groups were 18.9% and 17.6% respectively, p=0.76. At 6 months no discernible difference between the control and intervention groups was found with regard to BMI, blood pressure or lipid profile. In the whole cohort both groups saw significant drops in HbA1c, total- and LDL-cholesterol, but not in blood pressure or BMI. Conclusion: Text message life style intervention did not alter established cardiovascular risk factors including HbA1c, blood pressure, waist circumference or lipid profile. Type-2 diabetes in Kenya is characterized by early onset and a with a high residual cardiovascular risk despite enrollment into a diabetic care settin