Assessing the Impact of Infographics Messaging via Mobile Chat Application on HbA1c Levels and Behavior in Diabetic Patients: A Randomized Controlled Study

Abstract

Background: Lifestyle modification is the most important method for preventing diabetes and disease progression. Mobile-health technology studies show positive results in diabetic patients in developed countries, however, the results in developing countries are controversial. Objective: To assess the impact of infographic messaging on HbA1c levels and behavior in diabetic patients. Materials and Methods: A randomized controlled trial was conducted involving 165 diabetic patients from Chaiyaphum Hospital. Participants were randomized into a control group and a messaged group, with messages sent approximately three times per week to the latter. Follow-up assessments were conducted every three months for a total of nine months, measuring HbA1c, fasting blood glucose, blood pressure, and behavior using a questionnaire. The primary outcome measure was the rate of HbA1c change per visit. Regression analysis of repeated measures was performed to compare the mean difference between the groups. Results: Baseline characteristics were similar between groups, with no significant differences found. Overall, there was no significant difference in adjusted HbA1c change rate between groups (0.04, 95% CI –0.14 to 0.22, p=0.653). Subgroup analysis revealed no significant difference in patients receiving insulin treatment (–0.002, 95% CI –0.39 to 0.38, p=0.991). However, a significant decrease in the adjusted HbA1c change rate was observed in the messaged group for patients not receiving insulin treatment (–0.67, 95% CI –0.93 to –0.4, p<0.001). The messaged group also demonstrated a significant decrease in bad-behavior score (4.75±2.4, 95% CI 0.02 to 9.51, p=0.025). Conclusion: While infographic messaging via mobile phone chat application did not significantly reduce HbA1c levels in diabetic patients overall, it effectively improved diabetic behavior. Notably, for patients without insulin treatment, the intervention led to a significant decrease in adjusted HbA1c change rate, suggesting its potential effectiveness in this subgroup.