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Background Type 2 diabetes mellitus (T2DM) is an international problem of alarming epidemic proportions. T2DM can develop due to multiple factors, and it usually begins with prediabetes. Fortunately, this disease can be prevented by following a healthy lifestyle. However, many health care systems fail to properly educate the public on disease prevention and to offer support in embracing behavioral interventions to prevent diabetes. SMS messaging has been combined with cost-effective ways to reach out to the population at risk for medical comorbidities. To our knowledge, the use of nationwide SMS messaging in the Middle East as a screening tool to identify individuals who might be at risk of developing T2DM has not been reported in the literature. Objective The primary aim of this study was to assess the feasibility of conducting a series of SMS messaging campaigns directed at random smartphone users in Kuwait for the detection and prevention of T2DM. It was predicted that 1% of those receiving the text message would find it relevant and participate in the study. The secondary aim of this study was to assess the incidence of participation of those who were forwarded the initial text message by family members and friends. Methods In this study, 5 separate text message screening campaigns were launched inviting recipients to answer 6 questions to determine the risk of developing T2DM. If subjects agreed to participate, a link to the prediabetes screening test devised by the Centers for Disease Control and Prevention was automatically transmitted to their mobile devices. Those identified as high risk were invited to participate in a diabetes prevention program. Results A total of 180,000 SMSs were sent to approximately 6% of the adult population in Kuwait. Of these, 0.14% (260/180,000) of the individuals who received the SMS agreed to participate, of whom 58.8% (153/260) completed the screening. Surprisingly, additional surveys were completed by 367 individuals who were invited via circulated SMS messages forwarded by family members and friends. Altogether, 23.3% (121/520) qualified and agreed to participate in a diabetes prevention program. The majority of those who chose to participate in the prevention program were overweight, aged 45-65 years, and reported being less physically active than those who chose not to participate (χ22=42.1, P<.001). Conclusions Although health care screening via text messaging was found to have limited effectiveness by itself, it exhibited increased reach through shared second-party social media messaging. Despite the fact a subpopulation at possible risk of developing T2DM could be reached via text messaging, most responders were informed about the screening campaign by family and friends. Future research should be designed to tap into the benefits of social media use in health risk campaigns.

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BACKGROUND Diabetes mellitus can cause serious chronic medical comorbidities including heart and blood vessel disease, blindness, neuropathy, limp amputation, and kidney failure. Fortunately, this disease can be prevented or managed by following a healthy lifestyle. However, many healthcare systems fail to properly educate the public on disease prevention and to offer support in embracing behavioral interventions to prevent diabetes. OBJECTIVE To evaluate the feasibility, acceptability, and effectiveness of text message screening (TMS) using short message service (SMS) campaigns to detect people who might be at risk of developing type 2 diabetes mellitus (T2DM) in Kuwait. METHODS Five separate TMS campaigns were launched inviting recipients to answer 6 questions to determine risk of developing T2DM. If subjects agreed to participate, a link to the CDC prediabetes screening test was automatically transmitted to their mobile devices. Those identified as high risk were invited to participate in a diabetes prevention program. RESULTS A total of 180,000 SMSs were sent to 6% of the adult population in Kuwait. Of these, 260 individuals agreed to participate and 153 (58.8%) completed the screening. Surprisingly, additional surveys were completed by 367 individuals who were invited based on circulated SMS messages forwarded by family members and friends. One hundred twenty-one (N=121) qualified and agreed to participate in a diabetes prevention program. More women than men were forwarded the messages (p<0.001) and those who participated in the program were older, more overweight, and reported being less physically active (p<0.05). CONCLUSIONS Text messaging healthcare screening campaigns were found to have limited effectiveness alone but with increased reach through shared second-party social media messaging. Although a subpopulation who might be at risk of developing T2D can be reached using text messaging, most responders were informed about the screening campaign by family and friends. Future research designed to tap into the benefits of social media in health risk campaigns is encouraged.