Mobile Text Messaging for

Prevention of Type 2 Diabetes

Xiaolu Hou

The Diabetes Epidemic

Mobile Phone Prevalence

Mobile Text Messaging for

Delivery of Lifestyle Intervention
Demonstrated efficacy in increasing adherence to:
antiretroviral drugs
smoking cessation

Shown promising effects for diabetes self-management:

A1C, self-efficacy, eating behaviors, and diabetes selfcare/knowledge.

Recent RCT for mobile text messaging for T2DM

prevention among Indian men (aged 35-55) with IGT
reported a significant 9% reduction in progression to
T2DM in the text messaging intervention versus control
group.
Lester et al. The Lancet 2010; Free et al. The Lancet 2010; Holtz et al.
Telemed & e-Health 2012; Krishna et al. J Diabetes Science & Tech
2012; Ramachandran et al. The Lancet Diabetes & Endocrinol 2013

Primary Specific Aim

Determine the effectiveness of a mobile phone
text messaging-based diabetes prevention
lifestyle modification intervention compared to a
SC control among adults with prediabetes (IFG
or IGT) in:
increasing physical activity and healthful eating
reducing body weight and BMI

Secondary Specific Aims

Effectiveness of a mobile phone text messaging-based
diabetes prevention intervention in enhancing longer term
(6-month follow-up) maintenance of increases in PA and
healthful eating and weight/BMI reduction when compared
to a SC control group.
Changes in blood glucose levels, waist circumference,
serum lipid levels, blood pressure, and quality of life at
6, 12, and 18 months.
The cost/cost-effectiveness of interventions vs. control.
The extent to which beneficial effects of the mobile text
messaging intervention may be dose-dependent.

Participants
396 participants (132 per group)
Prediabetes (IFG or IGT)
BMI 25
Age 18
Ownership of mobile phone
Pre-action stage of change [transtheoretical model]

Intervention Groups
Low Frequency Mobile Text Messaging (LF-MTM)
Computer-generated messages targeting increased PA and
healthy eating based on the transtheoretical model.
2 text messages per week for 12 months

High Frequency Mobile Text Messaging (HF-MTM)

7 text messages per week (daily) for 12 months

Standard Card Control

Single-session 2-hour diabetes prevention educational
course at regional clinic within 1 month of baseline

Outcomes, Mediators, and Moderators

Primary Outcomes:

Proposed Mediators:

Stage of change
[Transtheoretical Model]

Nutrition Knowledge

Secondary Outcomes

Self-efficacy

Proposed Moderators:

Physical Activity
Dietary Intake
Body Weight / BMI
Blood Glucose
Waist Circumference
Serum Lipid Levels
Blood Pressure
Quality of Life
Cost/Cost-effectiveness
Dose-dependency of
Intervention Effects
Longer-term Maintenance of
Intervention Effects

Mobile Technology Literacy

Age

Sex

Race/Ethnicity

Income

Employment

Education

Potential Challenges
Recruitment of 396 participants in a reasonable
amount of time
Maintenance of low attrition rate
Potentially confounding variables
Mobile service outages and other potential causes
of failure to deliver intervention text messages

Overview of Research Design