diabetes mellitus ( dm ) is a global epidemic in the new millennium . the world health organization ( who ) has observed an apparent epidemic of diabetes that is strongly related to lifestyle and economic change to exceed 200 million over the next decade ; mostly with type 2 dm , and all are at risk of the development of complications . diabetes and its complications pose a major threat to public health resources , and who has projected the maximum increase in diabetes would occur in india . it is estimated that the prevalence of diabetes will rise to 5.5% in 2025 as compared to 4% in year 1995 . there is an increasing amount of evidence that the patient education is the most effective way to lessen the complications of diabetes and its management . recently mobile phones as a new delivery system can provide medical recommendations and prescriptions at the appropriate time and to accommodate for patients behavioral changes . mobile - based education and counseling is an important way of encouraging better provider - patient communication and will undoubtedly increase its application for improving health status of patients with chronic diseases . a delayed recognition of stress undoubtedly worsens the prognosis for survival for many diabetic patients . an attempt was made among diabetic patients for reduction stress attending a tertiary care hospital with following objectives : 
 to develop an intervention model for the reduction of stress among diabetic patientsto evaluate the developed intervention model in the proposed group . 
  to develop an intervention model for the reduction of stress among diabetic patients to evaluate the developed intervention model in the proposed group . it was a randomized controlled trial conducted over a period of 6 months that is , october 1 , 2012 to march 31 , 2013 after clearance by institutional ethics committee . the diabetic patients who attended the endocrinology outpatient department ( opd ) of a tertiary care hospital of india , during november 2012 were included in the study . patients aged 30 years and above , and on treatment for diabetes for at least 3 months , were included in the study . patients having gestational diabetes and major psychiatric disorders were excluded both from the study and control group as these have been identified as potential confounding factors . the prospect of this study was for reducing stress and which require patient compliance and co - operation , so these two groups were excluded . on an average , 56 respondents were interviewed per day ; endocrinology opds are held 5 days a week . considering the time and feasibility of the study , 100 subjects were included in the study ( calculated through convenience sampling , i.e. 4 weeks  5 days  56 subjects per day = 100 ) . starting at random , 50 patients were allocated to test group and 50 patients to control the group . the study subjects were interviewed using a predesigned , pretested , and semi - structured questionnaire . the stress score adapted in the questionnaire was cohen 's perceived stress scale , which contains 10-item about the feelings and thoughts during the past month . each item was rated on a 5-point scale ranging from never ( 0 ) to almost always ( 4 ) . positively worded items are reverse scored , and the ratings are summed , with higher scores indicating more perceived stress . the prospect of this study for the reduction of stress among diabetic patients was explained to the participants . then an sms containing some educational tips to decrease stress was sent every week to test group . they were contacted by phone calls by the investigator in every 3 weeks for 3 months by telephone by investigator and asked about their stress and counseled if required . all patients were motivated by investigator with the help of an endocrinologist to come for follow - up at 3 months . the information thus collected were processed and analyzed using spss v20.0 software ( ibm corp . independent t - test was done for comparison of continuous data between control and intervention groups , and chi - square test was for categorical data between these groups . the study included 100 patients aged 30 years and above , and on treatment for diabetes for at least 3 months , was included in the study . they were divided into the control group and intervention group and followed - up at 3 months . after 3 months , total 55 patients ( control = 21 , intervention = 34 ) came for follow - up . socio - demographic data among study population mean age was 54 years ( standard deviation = 11.5 ) overall ranging from 30 years to 80 years . about two - third of participants were males with similar distribution in both the groups ( intervention = 66% , control = 64% ) . half ( 50% ) of the participants lived in joint families followed by nuclear families ( 40% ) . most ( 83% ) were married and with either graduate or above graduate education ( n = 39% ) . no significant difference was observed in socio - demographic characteristics among both control and intervention groups [ table 2 ] . perceived stress scores at baseline self - reported stress was assessed among dm patients . at baseline , about 78% had higher than average stress scores meaning high stress while only 1% had the least stress score of much less than average with similar distributions throughout the scores . at 3 months follow - up , this proportion was reduced to less than half ( 46% ) for higher than average stress scores ; higher proportion of reduction was seen in the intervention group [ figure 1 ] . perceived stress scores after 3 months the average stress scores were similar ( 18.9 ) at baseline for control and intervention arms . at 3 months follow - up , however , these scores reduced to 17.05 in the intervention arm while they increased to 20.7 in the control arm [ figure 2 ] . error bar showing differences in perceived stress scores the error bar shows a significant difference of perceived stress scores between control and intervention group at follow - up . it was observed in our study , at baseline , 78% had higher than average stress scores . the average stress scores were similar ( 18.9 ) at baseline for control and intervention arms . at 3 months follow - up , this proportion was reduced to 46% for higher than average stress scores ; higher proportions seen in the intervention group . at 3 months follow - up , however , these scores reduced to 17.05 in the intervention arm while these increased to 20.7 in the control arm . this clearly indicates that talking with health personnel and getting some health messages has an impact in reducing stress among patients . in a study by zolfaghari et al . among 77 iranian patients with type 2 diabetes , sms group that received message daily for 12 weeks and telephone follow - up group were contacted twice weekly in 1 month and then once weekly for second and 3 month . this study suggests both telephone follow - up intervention and using sms of personal cellular phone improved glycated hemoglobin levels remarkably after 3 months in type 2 diabetic patients . pilot - tested the mobile phone - based intervention on 18 black adults with type 2 diabetes for 4 weeks , followed by in - depth , individual interviews with each participant . based on the interviews , the constant , daily communications reduced denial of diabetes and reinforced the importance of self - management . they responded positively to questions about self - management and their confidence increased in self - care . intensive lifestyle education and counseling about stress management along with constant touch with patients by phone calls and sms reminders is definitely helpful in reducing their stress . in patients with dm , increasing stress is of great concern as it increases complications . intervention in the form of intensive lifestyle education and phone calls and sms by the health provider significantly decrease their stress score . mobile - based education by the health provider has great potential to improve their mental status and increase patient - provider communication , and to decrease stress .
background : stress among diabetic patients is much more as compared to normal individuals . a delayed recognition of stress undoubtedly worsens the prognosis for survival for many diabetic patients . 
 hence , this study was planned to develop an intervention model for the reduction of stress among diabetic patients and to evaluate the developed intervention model in the proposed group.methods:this study was conducted in endocrinology outpatient department of a tertiary care hospital . 
 starting at random , the patients were allocated to control group and test group . 
 controls were given printed educational materials . 
 test group were counseled with intense lifestyle education using both printed materials and computers ; they were contacted by telephones by the investigator every 3 weeks for 3 months and sms were sent every week containing some educational tips.results:mean age was 54  11.5 years overall ranging from 30 years to 80 years . 
 about two - third of participants were males with similar distribution in both the groups ( intervention = 66% , control = 64% ) . 
 half ( 50% ) of the participants lived in joint families , followed by nuclear families ( 40% ) . 
 most ( 83% ) were married and with either graduate or above graduate education ( n = 39% ) . 
 no significant difference was observed in socio - demographic characteristics among both control and intervention groups ( p > 0.05 ) . 
 the average stress scores were similar ( 18.9 ) at baseline for control and intervention arms . at 3-month follow - up 
 , however , these scores reduced to 17.05 in the intervention arm while they increased to 20.7 in the control arm . at 3 months follow - up , higher proportion of stress reduction was seen in the intervention group.conclusions:intervention in the form of intensive lifestyle education and phone calls and sms significantly decrease their stress score . 
 mobile - based education has great potential to improve their mental status and increase patient - provider communication , and to decrease stress .