ArticlesEffectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial
Introduction
Primary prevention of type 2 diabetes is needed to reduce its increasing prevalence globally, particularly in low-income and middle-income countries.1 Several randomised controlled trials have shown that lifestyle modification can reduce conversion from prediabetes to type 2 diabetes by 50%.2, 3, 4, 5, 6, 7 However, such programmes are labour intensive and have not been widely implemented, even in high-income countries. Mobile phone messaging (text messaging or short message service [SMS]) is an alternative method for delivery of educational advice and motivation to achieve lifestyle modification.8, 9, 10, 11, 12
Much work has been done to assess the use of mobile technology in disease management.13 If successful, this method could be scalable, because mobile phones—with the low cost of SMS and their instant transmission—are used worldwide by people of all socioeconomic statuses.13, 14 Although the number of mobile phone messages sent globally tripled between 2007, and 2010,15 robust data to support a successful role of mobile phone messaging in disease management are scarce. A Cochrane review13 included only four randomised trials of 182 participants to provide a scientific evidence base for mobile phone messaging in management of all long-term disorders, and none of the studies assessed prevention of type 2 diabetes. Other reviews8, 16 have emphasised the paucity of randomised trials, although some data for disease management is emerging10, 17, 18 and a role for mobile phone messaging in improvement of adherence to antiretroviral therapy has been established for people with HIV infection.19 Despite the restricted evidence for mobile phone messaging in disease prevention,14 the method is effective as part of an intervention for smoking cessation.20
India has a high prevalence of type 2 diabetes and widespread mobile phone ownership. We assessed whether tailored mobile phone messaging encouraging lifestyle change could reduce incident type 2 diabetes compared with standard lifestyle advice in Indian men with impaired glucose tolerance.
Section snippets
Study design and participants
We did this prospective, parallel-group, randomised controlled trial at ten sites in southeast India between Aug 10, 2009, and Nov 30, 2012. Working Indian men were screened for eligibility by questionnaire. The men were employed in public-sector and private-sector industrial units in southeast India (Chennai, Tamil Nadu and Visakhapatnam, Andhra Pradesh). The study was done in the workplace and because 96% of the employees were men, we included only men in the trial. Participants' jobs were
Results
Figure 1 shows the trial profile. Of 2744 eligible participants, 1369 (50%) agreed to a second oral glucose tolerance test. Of these, 580 (42%) had persistent impaired glucose tolerance, of whom 43 (7%) did not wish to participate further. 537 participants were randomly assigned to the mobile phone messaging intervention (n=271) or to standard care (n=266), and were included in the primary analysis. Baseline characteristics were similar between groups (table 1). Most workers were in a skilled
Discussion
Our findings show that mobile phone messaging can be an effective technique for lifestyle modification to reduce incidence of type 2 diabetes. The mobile phone messages were generally well accepted (panel 4).
Participants in this trial were at particularly high risk for development of type 2 diabetes on the basis of 2 h glucose concentrations at first oral glucose tolerance test. The cumulative incidence of type 2 diabetes was lower in those who received the mobile phone messaging intervention
References (33)
- et al.
Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males
Diabetes Res Clin Pract
(2005) - et al.
Behavior change interventions delivered by mobile telephone short-message service
Am J Prev Med
(2009) - et al.
Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial
Lancet
(2010) - et al.
Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial
Lancet
(2011) - et al.
Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians
Lancet
(1991) - et al.
The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study
Lancet
(2008) - et al.
Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study
Diabetes Care
(1997) - et al.
The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1)
Diabetologia
(2006) - et al.
Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance
N Engl J Med
(2001)
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
N Engl J Med
Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis
BMJ
Diabetes management via mobile phones: a systematic review
Telemed J E Health
Reinforcement of adherence to prescription recommendations in Asian Indian diabetes patients using short message service (SMS)—a pilot study
J Assoc Physicians India
Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control
Diabetes Care
Mobile phone messaging for preventive health care
Cochrane Database Syst Rev
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