Evidence based review of type 2 diabetes prevention and management in low and middle income countries

Table 3 Diabetes management: Technology assisted interventions

Country	Ref.	Objective	Study design	Sample size/characteristics	Components of intervention	Measurements	Outcome measures	Conclusion
Bangladesh	Kibriya et al[72]	To evaluate effectiveness of HMBG	RCT	n = 64, 32 in each arm, T2DM requiring OHA/insulin, 35-64 yr, completed secondary school education, high SES	Health Education Sessions, HMBG Practical Sessions for 2 d	FBG, HbA1c	0, 3, 6, 9, 12, 15 and 18 mo	HMBG + education is cost-effective in developing country. FBG decreased by 2.49 mmol (P = 0.007) and HbA1c decreased by 1.37% (P = 0.02) in experimental group. FBG decreased by 1.47 mmol (P = 0.051) and HbA1c lost significance after 18 mo of follow up in control group
Bulgaria	Kempf et al[73]	To evaluate effectiveness of SMBG on T2DM patients	RCT	n = 124, 63 in SMBG group, 61 in control group	Structured lifestyle guidance manual, 150 test strips with blood glucose meter	HbA1c	0, 12 wk, 18 mo	At 12 wk of intervention the SMBG group significantly improved glycated hemoglobin (HbA1c) levels [from 7.4 to 6.9 (P < 0.001)], whereas HbA1c reduction were not significant in the control group. At 1.5-yr follow-up, in the control group HbA1c increased again, reaching baseline values (7.5%). In the SMBG group HbA1c remained stable [6.9%(P = 0.0003 for trend)]
China	Chen et al[75]	To evaluate the functionality of telehealth system	Two group experimental	n = 64, 32 in experimental and 32 in control, T2DM	Telehealth device package with blood glucose meter for frequent monitoring according to recommendations, telehealth data analysis platform, telephone to contact health care professional, diabetes education	HbA1c	0 and 1 yr	HbA1c decreased from 9.5 to 8 in telehealth group (P < 0.001), while in the control group, there was no significant improvement in HbA1c
India	Shetty et al[77]	To investigate feasibility of SMS	RCT	n = 215, 110 in SMS group and 105 in control group, diagnosed T2DM > 5 yr, 10% < HbA1c > 7%	SMS once in 3 d as reminders to follow diet, physical activity and prescription adherence reminders	HbA1c, FBG, Lipid profile	0, 4, 8 and 12 mo	SMS communication is acceptable and it improved health outcomes for diabetic patients. Mean FPG (185 mg/dL to 166, P < 0.002) and 2h PG 263 mg/dL to 220, P < 0.002) levels decreased significantly in the SMS group. There was no significant difference in the mean HbA1c values in both groups
Iran	Zolfaghari et al[76]	To evaluate effect of nurse short SMS vs telephone follow-ups	RCT	n = 80, 39 in SMS group and 42 in telephone follow-up group, T2DM, used oral medications only	SMS group received 6 messages every week with info on exercise, medication compliance, diet adherence; Telephone group received at least 2x a week call for 1st month and then weekly for 2nd and 3rd month, each call lasting 20 min	HbA1c, BMI	0 and 3 mo	HbA1c decreased -0.93 (P < 0.001) for telephone group and -1.01 (P < 0.001) for SMS group. Both follow-up interventions can decrease HbA1c levels
Iran	Nesari et al[34]	To evaluate effect of nurse telephone follow-up	RCT	n = 60, 30 in each group, < 65 yr, HbA1c > 7%	3 d diabetes self care education group before intervention, then telephone follow-up 2x/week for first month and then weekly for 2nd and third months with 30 min duration	HbA1c	0 and 3 mo	The change in HbA1c level was significant for the experimental group after 12 wk but not for the control group (-1.87%, P < 0.001 for the experimental group vs -0.4%, P < 0.15 for the control group)
Iran	Moattari et al[78]	To evaluate effectiveness of electronic education	RCT	n = 48, 24 in experimental and 24 in control, diagnosed T2DM, insulin usage, ability to use website/internet	Chat rooms, consultation service, educational films, personal file feedback from physician online	HbA1c, Lipid profile, FBG	0 and 3 mo	Electronic education program can be useful in improving metabolic parameters in T2DM patients sign differences. Change in HbA1c in experimental group was -2.03% (P < 0.0001) and -0.6 in control group. FBS change was -10.87 mg/dL (P = 0.681) in experimental group and -0.79 in control group
Malaysia	Ismail et al[74]	To evaluate effect of self-monitoring blood glucose	RCT	n = 105, 58 in intervention and 47 in control, T2DM, age 35-65 yr	Glucometer, health education, 2 d classes with demos of SMBG	HbA1c	0 and 6 mo	HbA1c level in the intervention group showed a statistically significant improvement of 1.3% (P = 0.001; 95%CI: 0.6-2.0), relative to the control group that underwent usual care
South Africa	Rotheram-Borus et al[79]	To evaluate feasibility of mobile phone-based peer support intervention	Single group	n = 22, diagnosed T2DM	Informational support meetings, weekly success sessions	BMI, blood glucose, Coping, Hours of sleep	0, 3 and 6 mo	Although the phone buddy system resulted in positive coping styles and better sleep, glucose levels increased in participants

HMBG: Home monitoring of blood glucose; RCT: Randomized control trial; T2DM: Type 2 diabetes mellitus; MS: Short message service; SMBG: Self-monitoring of blood glucose.