it is personal , highly transportable , and widely used , particularly in the western countries ( 1 , 2 ) .
however , text messaging coupled with specific management strategies has yet to be utilized effectively in developing countries with high prevalence of diabetes .
several studies showed that mobile phone might offer a useful means of providing information between clinic visits and might increase adherence to diabetes therapy regimens ( 3 - 5 ) .
the aim of this study was to evaluate the feasibility of short message service ( sms ) and its effect on glycemic control in adults with type 2 diabetes .
a total of 100 patients with type 2 diabetes with disorder duration of more than one year and no end organ complications who were on oral hypoglycemic agents and were followed at the diabetes clinics , security forces hospital , were recruited .
the following parameters were recorded before initiating sending sms : glycosylated hemoglobin ( hba1c ) , frequency of simple hypoglycemic attacks ( defined as blood glucose level < 2.22 mmol / l ) , frequency of severe hypoglycemic attacks ( hypoglycemia associated with seizure or come ) , frequency of hyperglycemic attacks ( defined as blood glucose of > 9.99
mmol / l ) , mean fasting blood sugar ( fbs ) level , mean postprandial blood glucose level , and frequency of blood glucose monitoring .
twenty educational multiple - choice questions for assessing patients knowledge were distributed . after four month of sending sms ,
the above parameters were recorded again and ten scoring questions to assess the quality of sms were answered by the participants .
the content of the sms program short messages prepared in simple , understandable , constructive arabic language .
the educational messages covered general diabetes care knowledge that included diabetes symptoms , signs , pathophysiology , etiology , diagnosis , diet therapy , psychotherapy , press news concerning diabetes , etc .
these messages were considered as reminding messages about blood glucose check - up and medications intake .
the messages were written by specialist in diabetes and diabetic educators , and then reviewed by the authors .
statistical analyses were performed using the wilcoxon signed rank test , to evaluate the differences in hba1c , fbs , postprandial blood glucose levels , incidence of hypoglycemic / hyperglycemic episodes , and other variables before and after the intervention .
the tests were two tailed and p < 0.05 was considered as significant deviation from the null hypothesis .
a written informed consent with the security forces hospital institutional board review approval was obtained from participants .
the average number of submitted sms messages was six messages ( range , 5 - 7 ) per patient per week with the total number of approximately 9600 messages over four months for all patients .
a total of 100 phone calls were primarily made to ensure that the patients had received the messages at the middle the trial .
mmol / l , the median frequency of documented simple hypoglycemic and hyperglycemic attacks per week were respectively zero and two , the mean hba1c was 9.9%  1.8% , the median frequency of blood glucose monitoring per day was zero , and the median score at the patient 's knowledge testing was 17 ( the maximum score was 20 ) .
post - sms delivery and during the last month of the tele - educational period were as follow : the mean fbs level , 8.60  3.16 mmol / l ; the mean postprandial blood glucose level , 10.65  3.20 mmol / l ; the median frequency of documented simple hypoglycemic and hyperglycemic attacks per week , zero and two , respectively ; the mean hba1c , 9.5%  1.7% , the median frequency of blood glucose monitoring per day , one ; and the median score at the patients ' knowledge testing , 19 .
the mean score of sms quality , assessed by the parents , was 8.7 out 10 .  
data are presented as median ( interquartile range ) or mean  sd .   abbreviations : sms , short message service ; fbs , fasting blood sugar ; and hba1c , glycosylated hemoglobin .
growing evidence suggests that utilizing mobile phones might improve diabetes self - management and clinical outcomes ( 6 - 10 ) .
a meta - analysis examined the effectiveness of mobile phone technology in diabetes mellitus care by reviewing 15 english - language articles , published between january 2002 and march 2012 .
studies that used mobile phone intervention and reported changes in diet , physical activity , and blood glucose and/or hba1c levels were retrieved .
overall , significant improvements were observed in blood glucose and/or hba1c concentration , adherence to medication , healthy lifestyle , and self - efficacy ( 11 ) .
our study is probably among the first ones to be conducted in the arab peninsula where diabetes prevalence is very high . in our study , the change in post prandial blood sugar was remarkable , which significantly decreased the level of hba1c .
holtz et al . identified peer - reviewed articles published between 2000 and 2010 and analyzed 21 articles in a systematic literature review .
overall , 71% of the studies had used a study - specific application , which had supplemental features in addition to text messaging .
the outcomes varied considerably across studies , but some positive trends such as improved self - efficacy , hba1c , and self - management behaviors were noted ( 12 ) . in our cohort , sms positively modified patients behavior . although the frequency of blood glucose monitoring was not increased significantly , the rate of glycemic control was improved .
a feasibility study was conducted to evaluate the utility of sms in supporting 42 iraqi adults with newly diagnosed type 2 diabetes over 29 weeks .
hba1c decreased from 9.3% ( sd , 1.3% ) to 8.6% ( sd , 1.2 ) ( p = 0.001 ) .
mean knowledge score rose from 8.6 ( sd , 1.5 ) at baseline to 9.9 ( sd , 1.4 ) six months after receipt of sms ( p = 0.002 ) .
all patients were satisfied with the text messages and wished the service to be continued after the study ( 13 ) .
the effect of distance education via mobile phone text messaging on knowledge , attitude , practice , and self - efficacy was evaluated in patients with type 2 diabetes mellitus in iran .
the results in the experimental group showed significant improvement in hba1c ( p = 0.024 ) , low density lipoprotein ( p = 0.019 ) , cholesterol ( p = 0.002 ) , and micro albumin ( p  0.001 ) . the knowledge ( p  0.001 ) , practice ( p  0.001 ) , and self - efficacy ( p  0.001 ) were also improved ( 14 ) . in a randomized study in india , the acceptability and feasibility of using sms via cell phones to ensure adherence to management prescriptions was tested .
we did not test medications adherence in our study ; however , the patients admitted that their compliance with drug intake was better .
a one - way video message about diabetes self - care was sent to 65 patients with type 2 diabetes for one year .
participants were randomized to receive the usual care or the self - care video messages from their diabetes nurse practitioner .
participants who received the messages had a larger rate of decline in hba1c than people who received usual care had ( 0.2% difference over 12 months ) ( 16 ) .
we believe that multimedia message service might have a better audiovisual effect in comparison to regular sms ; however , it should be tested in further studies . mobile phone text educational and interactive messaging service might provide benefit in supporting diabetes self - management .
the results of this study might help to design future text message interventional support programs for other chronic illnesses .
 background : mobile phone text messaging has rapidly become a socially popular form of communication . 
 several studies showed that mobile phone might offer a useful means of providing information between clinic visits and might increase adherence to diabetes therapy regimens.objectives:we conducted a study to evaluate the effect of mobile phone short message service ( sms ) on glycemic control in saudi patients with type 2 diabetes.patients and methods : one hundred patients ( mean age , 41  9.5 years ) were selected at the security forces hospital , riyadh , saudi arabia , and provided with daily educational , reminding sms messages for four months . 
 glycosylated hemoglobin ( hba1c ) level , frequency of hypoglycemic and hyperglycemic attacks , and compliance with blood glucose monitoring were recorded before and after the trial.results:in addition to significant improvement in patients knowledge , mean fasting blood glucose level improved from 8.60  3.16 to 7.77  3.11 
 mmol / l and mean hba1c decreased from 9.9%  1.8% to 9.5%  1.7%.conclusions : mobile phone text messaging increased adherence to diabetes therapy and improved the clinical outcome in saudi patients with type 2 diabetes . 
1. Background
2. Objectives
3. Patients and Methods
4. Results
5. Discussion