Effect of mobile reminders on screening yield during opportunistic screening for type 2 diabetes mellitus in a primary health care setting: A randomized trial

Abstract

Objective. We wanted to study whether mobile reminders increased follow-up for definitive tests resulting in higher screening yield during opportunistic screening for diabetes. Methods. This was a facility-based parallel randomized controlled trial during routine outpatient department hours in a primary health care setting in Puducherry, India (2014). We offered random blood glucose testing to non-pregnant non-diabetes adults with age >30 years (667 total, 390 consented); eligible outpatients (random blood glucose ≥ 6.1 mmol/l, n = 268) were requested to follow-up for definitive tests (fasting and postprandial blood glucose). Eligible outpatients either received (intervention arm, n = 133) or did not receive mobile reminder (control arm, n = 135) to follow-up for definitive tests. We measured capillary blood glucose using a glucometer to make epidemiological diagnosis of diabetes. The trial was registered with Clinical Trial Registry of India (CTRI/2014/10/005138). Results. 85.7% of outpatients in intervention arm returned for definitive test when compared to 53.3% in control arm [Relative Risk = 1.61, (0.95 Confidence Interval - 1.35, 1.91)]. Screening yield in intervention and control arm was 18.6% and 10.2% respectively. Etiologic fraction was 45.2% and number needed to screen was 11.9. Conclusion. In countries like India, which is emerging as the diabetes capital of the world, considering the wide prevalent use of mobile phones, and real life resource limited settings in which this study was carried out, mobile reminders during opportunistic screening in primary health care setting improve screening yield of diabetes.

Keywords: CI, confidence interval; CTRI, Clinical Trial Registry of India; Diabetes mellitus, type 2; FBG, fasting blood glucose; HbA1C, glycosylated hemoglobin; India; Loss to follow-up; NNS, number needed to screen; NPCDCS, National Programme for Prevention and Control of Diabetes, Cardiovascular diseases and Stroke; OPD, Out Patient Department; Operational research; Opportunistic screening; Outpatients; PHC, Primary Health Centre; PPBG, postprandial blood glucose; Primary Health Centre; Primary health care; RBG, random blood glucose; RCT, randomized controlled trial; Randomized controlled trial; Reminder system.

Fig. 1

Participant flow during opportunistic screening for diabetes at Primary Health Centre, Lawspet, Puducherry, India (2014).