The effect of electronic reminders on risk management among diabetic patients in low resourced settings

Background: Information technology has potential to improve health care delivery particularly among individuals with chronic diseases such as diabetes in low and middle-income countries (LMIC). Research on the usefulness of information technology tomanage persons livingwith chronic diseases is scarce in LMIC.We sought to evaluate the effect of an electronic reminder systemon cardiovascular risk factors (blood pressure, heart rate, and fasting plasma glucose) and adherence to clinical appointments among persons living with diabetes. Research Design and Methods: A randomized controlled design was used to recruit 200 diabetic patients (intervention n = 100, control n = 100) from the National Diabetes Management Research Centre, Accra. All patients received usual diabetes care. The intervention group was given electronic reminders for their clinical appointments and their physicians were prompted with abnormal laboratory results for six months. Results: Baseline characteristics were largely similar for both groups. At six months follow up, the mean reductions of all the cardiovascular risk factors in the intervention group were significantly greater than in the control group: -1.7 kg/m² versus -1.1 kg/m²(p = 0.002) for BMI; -4.7 mmHg versus -2.8 mmHg (p = 0.002) for SBP; -5.3mmH versus -3.1 mmHg (p = 0.001) for DBP; -1.7 bpm versus -0.1 bpm (p = 0.001) for heart rate and -2.3 mmol/L versus -1.6 mmol/L (p = 0.001) for fasting plasma glucose, respectively. Adherence to appointment schedules was also significantly higher in the intervention group compared with the control group (97.8% versus 89.4%, p = 0.010). Conclusions: Locally developed electronic initiatives such as this resulted in improved cardiovascular risk factors and effective compliance to clinical practices and improved quality of care for persons living with diabetes.