Telehealth and challenges of statin adherence in patients with diabetes: a randomized controlled trial.

Background: The success of any therapeutic regimen can be achieved only if patients adhere to the prescribed regimen. Finding an effective intervention to improve patient adherence is challenging.

Aim: To evaluate the effect of telehealth through short messaging services (SMSs) on adherence to statins in patients with diabetes.

Methods: This was a randomized clinical trial. Patients with diabetes mellitus were referred to the Center of Diabetes and Endocrinology at Assiut University Hospital and were assessed for eligibility. Ninety participants were randomly assigned to either the intervention or control group. Reminder SMS messages were regularly sent to the intervention group. Follow-up was performed at 6 and 12 weeks. Medication Adherence Report Scale-5 (MARS-5) and pill counting (PC) were used to measure adherence. The lipid profile, incidence of acute cardiovascular events, and mortality were assessed as secondary outcomes.

Results: After six weeks, both groups exhibited similar adherence rates based on the subjective MARS-5 score. However, the intervention group demonstrated significantly better PC adherence than the control group. By the 12-week follow-up, the intervention group showed modest but statistically significant improvements in adherence rates (MARS-5, PC), along with reductions in total cholesterol, LDL-c levels, morbidity, and mortality incidence during the second follow-up period. These improvements were consistently greater in the intervention group compared to the control group ( < 0.05).

Conclusions: Telehealth through SMS has been shown to positively impact statin adherence in patients with diabetes, leading to an improved lipid profile, a reduced risk of acute cardiovascular events, and lower overall mortality.

Trial Registration: https://www.clinicaltrials.gov. Identifier: NCT 05872919 Date of registration July 15-2023.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12913-025-13295-3.