Change in Adherence and Glycemic Control Following WhatsApp-Based Education and Interactive Reminders among Diabetes Patients

Abstract

Introduction: Type 2 diabetes mellitus (DM) is a non-communicable disease with increasing prevalence and low adherence globally. Therefore, this study aims to evaluate changes in medication adherence and glycemic control after a WhatsApp-based education and interactive reminders among outpatients receiving insulin therapy. Methods: A pre-experimental study used a prospective one-group pre-test-post-test design among outpatients receiving insulin in a hospital. The intervention included DM education at the initial meeting, followed by educational videos and weekly interactive reminders provided through WhatsApp for 6 weeks. Patient knowledge was assessed with Diabetes Knowledge Questionnaire (DKQ) and adherence to medication was assessed using Adherence to Refills and Medications Scale (ARMS). Glycemic control indices (fasting blood glucose (FBG), two hours of postprandial blood glucose (2hPPBG), glycated hemoglobin (HbA1c)) were measured before and after the intervention. Additionally, a paired t-test was used to measure the effect of the intervention on knowledge, adherence, and glycemic control indices. Results: Among the 122 patients who fulfilled the inclusion criteria, there was a significant increase in knowledge (p < 0.001), with the proportion of highly knowledgeable patients rising from 19.7% to 38.5%. The increase in adherence to medication from 30.3% to 39.3% was not statistically significant (p = 0.228). Glycemic control indices showed a significant improvement (p < 0.001), with mean HbA1C, FBG, and 2hPPBG decreasing from 8.63% to 7.85%, 152.18 mg/dl to 138.72 mg/dl, and 268.84 mg/dl to 228.66 mg/dl, respectively. Conclusion: Following the 6 weeks WhatsApp-based education and interactive reminders, improvement were observed in patient knowledge and glycemic control indices, but medication adherence did not change significantly. This study lacked a control group, the findings represent observed changes after the study period and require confirmation in controlled studies with longer follow-up.