Text Message Support for Weight Loss in Patients With Prediabetes: A Randomized Clinical Trial

Abstract

OBJECTIVEAlthough the benefits of in-person Diabetes Prevention Program (DPP) classes for diabetes prevention have been demonstrated in trials, effectiveness in clinical practice is limited by low participation rates. This study explores whether text message support enhances weight loss in patients offered DPP classes. RESEARCH DESIGN AND METHODSEnglish-and Spanish-speaking patients with prediabetes (n = 163) were randomized to the control group, which only received an invitation to DPP classes as defined by the Centers for Disease Control and Prevention, or to the text messageaugmented intervention group, which also received text messages adapted from the DPP curriculum for 12 months. RESULTSMean weight decreased 0.6 pounds (95% CI 22.7 to 1.6) in the control group and 2.6 pounds (95% CI 25.5 to 0.2) in the intervention group (P value 0.05). Three percent weight loss was achieved by 21.5% of participants in the control group (95% CI 12.5-30.6), compared with 38.5% in the intervention group (95% CI 27.7-49.3) (absolute difference 17.0%; P value 0.02). Mean glycated hemoglobin (HbA 1c ) increased by 0.19% or 2.1 mmol/mol (95% CI 20.1 to 0.5%) and decreased by 0.09% or 1.0 mmol/mol (95% CI 20.2 to 0.0%) in the control group and intervention participants, respectively (absolute difference 0.28%; P value 0.07). Stratification by language demonstrated a significant treatment effect in Spanish speakers but not in English speakers. CONCLUSIONSText message support can lead to clinically significant weight loss in patients with prediabetes. Further study assessing effect by primary language and in an operational setting is warranted.Approximately one-third of Americans have prediabetes, defined by a blood glucose level above the upper limit of normal but below the threshold for the diagnosis of diabetes. Patients with prediabetes are at elevated risk of developing type 2 diabetes, heart attack, and stroke (1), with low-income and Latino patients representing a disproportionate share of those who progress to diabetes (2,3). Moderate weight loss is effective in preventing progression from prediabetes to overt diabetes, with benefits that persist long-term even with partial weight regain (4-6). Intensive behavioral interventions are effective for diabetes prevention (5,7), with a 16% reduction in risk for every kilogram (2.2 pounds) of weight loss (8).

Comment on Fischer et al. Text Message Support for Weight Loss in Patients With Prediabetes: A Randomized Clinical Trial. Diabetes Care 2016;39:1364–1370

“…We read with great interest the article by Fischer et al (1) that was recently published in Diabetes Care. Although we congratulate the authors for their encouraging findings on the impressive role of text messaging support for weight loss management in prediabetes, their results raise several important concerns.…”

Response to Comment on Fischer et al. Text Message Support for Weight Loss in Patients With Prediabetes: A Randomized Clinical Trial. Diabetes Care 2016;39:1364–1370

“…We thank Afarideh et al (1) for their thoughtful discussion of our study of text message support for weight loss in patients with prediabetes (2). We agree that the differential impact by language of the text message intervention was striking and merits further exploration.…”

Walk Long and Prosper: What Is the Optimal Way to Help People Achieve Their Goals?

“…Indeed, other studies have observed changes in behavior related to daily reminders. 3 As a result, these results also raise the question of how feedback could be optimized to achieve behavior change.…”