Short- and long-term effects of real-time medication monitoring with short message service (SMS) reminders for missed doses on the refill adherence of people with Type 2 diabetes: evidence from a randomized controlled trial

Aims To investigate short- and long-term effects of real-time monitoring medication use combined with short message service (SMS) reminders for missed doses on refill adherence to oral anti-diabetic medication. Methods A randomized controlled trial with two intervention groups and one control group involving 161 participants with Type2 diabetes with suboptimal adherence. For 6months, participants in the SMS group (n=56) were monitored and received SMS reminders if they missed their medication. Participants in the non-SMS group (n=48) were only monitored. The control group (n=57) was not exposed to any intervention. Primary outcome measure was refill adherence to oral anti-diabetic medication. Multi-level regression analyses were performed to examine intervention effects on adherence between and within groups after 1 and 2years of follow-up. Results At baseline, mean refill adherence was comparable between the groups. After 1year, adherence in the SMS group was significantly higher than in the control group (79.5% vs. 64.5%; P<0.001) and showed a significant improvement from baseline (+16.3%; P<0.001). Mean adherence in the non-SMS group reached 73.1% (+7.3%; P<0.05), but did not differ from the control group (P=0.06). After 2years, the improved adherence in the SMS group persisted and remained significantly higher than in the control group (80.4% vs. 68.4%; P<.01), contrary to the non-SMS group whose adherence approached baseline level again (65.5%). Conclusions This study shows the long-term effectiveness of real-time medication monitoring combined with SMS reminders in improving refill adherence. This new reminder system can strengthen the self-management of people with diabetes.