Regular mobile phone messages containing advice with healthy lifestyles

Mobile phone messaging can be an effective technique for lifestyle modification to reduce the incidence of type 2 diabetes in India and other developing countries, says a study published in British medical journal The Lancet.

The study, “Effectiveness of mobile phone messaging in prevention of type 2 diabetes through lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial,” was done by A. Ramachandran and others. It has shown that the cumulative incidence of type 2 diabetes was lower among those who received the mobile phone messaging intervention during the two-year trial than those in controls.

The research evaluates a programme, which used a simple, inexpensive text messaging service so as to try to prevent type 2 diabetes in men aged 35-55.

In a group of 537 patients, 18 per cent of the participants who received regular messages containing information about healthy lifestyle and the benefits of physical activity and diet developed type 2 diabetes, compared with 27 per cent in the control group who did not receive the messages.

This is the first trial in any country to show the benefits of a messaging service as a technique to prevent type 2 diabetes and the findings show the same preventive effectiveness as those of direct contact methods. This has particular relevance for rural or remote areas where direct contact is difficult or expensive.

The study was done on the men at 10 sites in industrial units of Chennai and Visakhapatnam. Participants were at a high risk of type 2 diabetes on the basis of 2 h glucose concentrations at the first oral glucose tolerance test.

“We aimed to induce dietary change and increase physical activity. Mobile phone messaging was associated with reduced dietary energy intake on recall; however, reported physical activity and bodyweight were similar in the intervention and control groups,” said Dr. Ramachandran, chairperson of Dr. A. Ramachandran’s Diabetes Hospitals, Chennai.

The study assessed 8,741 participants for eligibility and 537 were randomly assigned to either mobile phone intervention (271) or standard care (266) for two years.

The cumulative incidence of type 2 diabetes was lower among those who received mobile messages than in controls: (50) or 18 per cent participants in the intervention group developed type 2 diabetes, against 73 or 27 per cent in the control group.

“The SMSes were sent twice a week, and we had a mechanism to ensure that they were received. We modified messages from time to time and we also know that SMSes were acceptable to 97 per cent of those who received them. This was important because we were interfering in personal lives,” Dr. Ramachandran told The Hindu.

“India has a high prevalence of type 2 diabetes and widespread mobile phone ownership. We assessed whether tailored mobile phone messaging to encourage lifestyle change could reduce type 2 diabetes compared with standard lifestyle advice among Indian men with impaired glucose tolerance,” the study says.

In 2008, 1.8 million individuals died prematurely because of type 1 and 2 diabetes, with more than 80 per cent of these deaths taking place in low-income and middle-income countries.

High levels of mobile phone ownership across countries of all income economies and across all socio-economic groups hold the potential to scale up effective health interventions for large populations.

“We chose mobile because of its high penetration, the low cost of SMS and high scalability,” Dr. Ramachandran said.

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