Text Messages Do Not Improve Follow-Up Compliance in Patients With Diabetic Macular Edema

Female doctor examining a male patient at online
Researchers in India evaluated whether reminders via short messaging service impacted compliance with attending appointments for follow-up treatment.

Success in treatment often is dependent upon patients’ commitment to follow-up, despite any interfering challenges that may arise. Patients with center involved sight-threatening diabetic macular edema (DME) were not significantly more likely to comply with attending scheduled follow-up eye exams when they received reminders via short messaging service (SMS), researchers found in a study published in Ophthalmology Retina.

This is the first study in which researchers sought to demonstrate the role of SMS in encouraging patients with this condition in scheduling follow-ups.

The researchers conducted a single-blinded randomized clinical trial in which they recruited patients with diabetes and center involved sight-threatening DME in a tertiary eye hospital. The included patients had received at least 1 intravitreal injection for DME and owned a mobile phone.

The researchers randomly assigned half of the patients (n=100) to an intervention group (SMS reminder) and the others (n=100) to a control group (no SMS reminder). The mean age of the patients was 59.5 years (standard deviation (SD): 10 years) and the mean duration of diabetes was 14.7 years (SD: 7.9 years).

The patients in the intervention group received up to 3 SMS messages for 1 month before their appointment that reminded them of their upcoming appointment. The message informed patients of the doctor they would see, and the time, date and location of the appointment. The control group participants did not receive any further reminders of their follow-up appointment. The researchers called patients who did not comply with follow-up treatment to find out why they did not attend the appointment.

The researchers did not find any significant difference in attendance rate between the groups of individuals, and 21% of patients with DME were lost to follow-up. Attendance also did not seem to depend on whether the patient paid for their treatment.

Reasons for noncompliance in the intervention group included no leave from work (n=6), associated comorbidities (n=4), financial difficulties (n=3), distance traveled (n=2), no attender to accompany (n=2), and treatment dissatisfaction (n=2). Control group individuals reported reasons including no leave from work (n=4), distance traveled (n=3), and associated comorbidities (n=3). The researchers also listed “unable to contact/invalid contact number” as a reason for noncompliance for 5 patients in the control individuals.

Limitations of the study include the possibility that the study itself encouraged follow-up awareness. The study also notes its limited sample size.

“Our study highlights the need to employ a multi-pronged effort that includes developing education programmes to generate awareness, ensuring adequate treatment cost coverage and setting up policies at the workplace that both enables and supports adherence to hospital follow-up appointments for patients with DME,” the study authors said.


Kumar G, Velu S, Prakash VJ, et al. Attendance rate in patients with diabetic macular edema receiving short messages. Ophthalmol Retina. Published online March 7, 2021. doi:10.1016/j.oret.2021.03.005