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mHealth and wearable health technologies
Original article
SMS-based intervention in type 2 diabetes: clinical trial in Senegal
  1. Matthieu Wargny1,2,
  2. Line Kleinebreil3,
  3. Said Norou Diop4,
  4. Maïmouna Ndour-Mbaye4,
  5. Mady Ba5,
  6. Beverley Balkau6,7,
  7. Dominique Simon8
  1. 1CIC d’Endocrinologie, Maladies Métaboliques et Nutrition, CHU de Nantes, Nantes, France
  2. 2L’Institut du Thorax, INSERM UMR 1087, UNIV Nantes, CHU de Nantes, Nantes, France
  3. 3Université Numérique Francophone Mondiale, Hôpital national de Saint Maurice, Saint-Maurice, France
  4. 4Centre du Diabète Marc Sankalé, Centre hospitalier Abass Ndao, Dakar, Sénégal
  5. 5Bureau du représentant de l’OMS pour le Sénégal Almadies, Lotissement Ngor-Extension, Dakar, Sénégal
  6. 6INSERM U-1018, CESP, Team 5, Villejuif, Villejuif
  7. 7Université Paris-Saclay, Université Paris-Sud, Université Versailles Saint-Quentin en Yvelines, Versailles, France
  8. 8ICAN, Hôpital de la Pitié-Salpêtrière, Paris, France
  1. Correspondence to Dr Matthieu Wargny, CIC d’Endocrinologie, Maladies Métaboliques et Nutrition, CHU de Nantes, Nantes 44000, France; matthieu.wargny{at}gmail.com

Abstract

Objective Since 2014 Senegal has benefited from regular awareness-raising Short Message Service (SMS) campaigns (Be He@lthy, Be Mobile initiative) directed at people who have signed up, for free, to the ‘mDiabète’ programme. We report on an evaluation of its impact on diabetes control.

Design The clinical trial was designed to send daily SMS during 3 months to people with type 2 diabetes. Due to centre randomisation, SMS were sent from inclusion (M0) to month 3 (M3) to people in centre S and from M3 to month 6 (M6) to people in centre P.

Setting Medical centre S in the northwestern suburbs of Dakar; centre P in Popenguine, 70 km south of Dakar.

Participants In February 2017, people with type 2 diabetes were consecutively recruited in the two centres. Complete data were available from 186 of these people.

Main outcome measures HbA1c was measured in the two centres with the same assay throughout the study. The primary end point was the difference between centres for the change in HbA1c from M0 to M3. Secondary end points were the evolution of HbA1c in centres S and P between M3 and M6.

Results The HbA1c change from M0 to M3 in centre S was better than in centre P, with a median difference of −0.4%, quartiles (−1.0; 0.3) versus 0.2% (-0.5; 0.8), respectively (p=0.0038). HbA1c decreased over the 3 months after having stopped SMS in centre S and was confirmed in centre P. The campaign cost was €2.5 (US$3.1) per person.

Conclusions In Senegal, SMS sending was associated with an improved glycaemic control in people with type 2 diabetes. As SMS has a high penetration in low-income, middle-income countries where medical resources are scarce, health interventions using mobile telephones should be developed to facilitate exchanges between people with diabetes and medical teams; this may reduce diabetes-related complications.

  • mhealth
  • diabetes
  • affordable

https://doi.org/10.1136/bmjinnov-2018-000278

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    Footnotes

    • Contributors SND and MN-M brought their field experience and chose the two study centres. MN-M and LK wrote the original protocol and submitted it to the ethics committee, with the support of MB from WHO local office. SND and LK supervised the local investigators’ training and the progress of the study. BB, DS and MW performed the statistical analysis. DS and MW wrote the original draft. All authors participated in the correction of the draft and the final writing of the manuscript.

    • Funding This study was funded by the World Health Organization.

    • Competing interests MW and DS received personal fees from the WHO for the analysis and writing of the submitted manuscript. MB is a current employee of WHO. SND received fees from ITU as a temporary consultant in the m.Diabète project Sénégal, and from SANOFI Afrique as a member of the African advisory board. MN-M received consultant fees from ITU.

    • Patient consent Informed consent was obtained from all included patients.

    • Ethics approval Senegal National Ethics Committee for Scientific Research.

    • Provenance and peer review Not commissioned; externally peer reviewed.