BackgroundIn low/middle income countries like India, diabetes is prevalent and health care access limited. Most adults have a mobile phone, creating potential for mHealth interventions to improve public health. To examine the feasibility and initial evidence of effectiveness of mDiabetes, a text messaging program to improve diabetes risk behaviors, a global nonprofit organization (Arogya World) implemented mDiabetes among one million Indian adults.ObjectiveA prospective, parallel cohort design was applied to examine whether mDiabetes improved fruit, vegetable, and fat intakes and exercise.MethodsIntervention participants were randomly selected from the one million Nokia subscribers who elected to opt in to mDiabetes. Control group participants were randomly selected from non-Nokia mobile phone subscribers. mDiabetes participants received 56 text messages in their choice of 12 languages over 6 months; control participants received no contact. Messages were designed to motivate improvement in diabetes risk behaviors and increase awareness about the causes and complications of diabetes. Participant health behaviors (exercise and fruit, vegetable, and fat intake) were assessed between 2012 and 2013 via telephone surveys by blinded assessors at baseline and 6 months later. Data were cleaned and analyzed in 2014 and 2015.Results982 participants in the intervention group and 943 in the control group consented to take the phone survey at baselne. At the end of the 6-month period, 611 (62.22%) in the intervention and 632 (67.02%) in the control group completed the follow-up telephone survey. Participants receiving texts demonstrated greater improvement in a health behavior composite score over 6 months, compared with those who received no messages F(1, 1238) = 30.181, P<.001, 95% CI, 0.251-0.531. Fewer intervention participants demonstrated health behavior decline compared with controls. Improved fruit, vegetable, and fat consumption (P<.01) but not exercise were observed in those receiving messages, as compared with controls.ConclusionsA text messaging intervention was feasible and showed initial evidence of effectiveness in improving diabetes-related health behaviors, demonstrating the potential to facilitate population-level behavior change in a low/middle income country.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ACTRN): 12615000423516; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367946&isReview=true (Archived by WebCite at http://www.webcitation.org/6j5ptaJgF)

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This article presents the author's reflections on leadership and creating and running a nonprofit; in this case, the global health organization Arogya World, started in 2010. In that year, I saw noncommunicable diseases (NCDs)—chronic diseases including diabetes, cancer, heart disease, lung disease, and mental illness—as the next big frontier in global health, and one worth dedicating the rest of my life to. Statistics from the World Health Organization are noted around the prevalence and prevention of NCDs. Diabetes and its prevention in India is Arogya World's focus area because I have seen firsthand what diabetes does. I have the disease, as do others in my family. (“Arogya” means freedom from disease in Sanskrit.) Arogya World is a small nonprofit, but it thinks big and aims to be mighty. It has partnered with such entities as Emory University and the multinational company Nokia; as well as Northwestern University and Stanford's CARE (Center for Asian Health Research and Education). The conclusion notes that leaders are both thinkers and doers, with a good sense of self‐worth and a deep sense of purpose. They make meaningful contributions to society through being authentic, accountable, and delivering on their promises.