Researchers tested a new digital health program called PREDIABETEXT that sends three text messages per week to people at risk of developing type 2 diabetes. The study involved 365 patients and 58 doctors across Spain over 6 months. While the text messages didn’t significantly lower blood sugar levels as hoped, patients really liked receiving the practical diet and lifestyle tips. Doctors appreciated the training they received, though they wanted shorter, more flexible formats. The findings suggest text messaging programs show promise for keeping people engaged in their health, but stronger interventions may be needed to actually prevent diabetes.

The Quick Take

  • What they studied: Whether sending three personalized text messages per week to people with prediabetes (high blood sugar that isn’t quite diabetes yet) could help prevent them from developing type 2 diabetes
  • Who participated: 365 patients with prediabetes (average age 60, about half were women) from 16 primary care clinics in Spain, plus 58 doctors who worked with these patients
  • Key finding: After 6 months, the text message program did not significantly lower blood sugar levels compared to regular care. However, patients enjoyed the messages and found them helpful for making lifestyle changes
  • What it means for you: Text message reminders about diet and exercise may help you stay motivated and engaged with your health, but they alone may not be strong enough to prevent diabetes. You might need additional support like counseling or more intensive programs to see real changes in your blood sugar levels

The Research Details

This was a cluster randomized controlled trial, which means doctors’ offices were randomly assigned to different groups rather than individual patients. The study lasted 6 months and compared three approaches: one group received only text messages, another group received text messages plus their doctors got special online training, and a control group received regular care as usual. The text messages were personalized and sent three times per week with tips about diet, exercise, and lifestyle changes. After the main study ended, researchers interviewed 8 patients and 7 doctors to understand what they thought about the program.

The study was designed to be ‘pragmatic,’ meaning it tested the program in real-world conditions at actual doctor’s offices rather than in a controlled lab setting. This makes the results more relevant to everyday life. Researchers measured blood sugar control using a test called HbA1c, which shows average blood sugar levels over 3 months. They also looked at other health measures and asked patients and doctors about their experiences.

Testing programs in real doctor’s offices is important because it shows whether something actually works when doctors and patients use it in their daily lives. This approach helps researchers understand not just whether something works, but also whether people will actually use it and whether doctors can realistically deliver it. The study also included feedback from real patients and doctors, which helps identify what needs to be improved.

This study has several strengths: it was randomized (reducing bias), it included a control group for comparison, and it involved real patients in real clinics. However, the study only lasted 6 months, which may not be long enough to see major changes in blood sugar levels. The sample size of 365 patients is moderate—larger studies might show different results. The fact that the main outcome (blood sugar reduction) didn’t reach statistical significance is important to note, meaning the results could have happened by chance. The qualitative interviews with patients and doctors provide valuable real-world insights that numbers alone cannot capture.

What the Results Show

The main finding was disappointing: neither text message group showed significant improvement in blood sugar control compared to regular care. The group receiving only text messages had a tiny decrease in HbA1c of 0.05 percentage points (not statistically significant), and the group receiving text messages plus doctor training had a similar tiny decrease of 0.04 percentage points (also not significant). In simple terms, the blood sugar improvements were so small they could have happened by chance.

However, the qualitative interviews revealed important positive feedback. Patients appreciated receiving the text messages and found them practical and helpful. They liked the dietary advice and the frequency of the messages. Patients suggested improvements like more personalized messages, links to recipes, and follow-up calls from nurses. This suggests the program was engaging even if it didn’t significantly lower blood sugar.

Doctors also had positive feedback about the online training they received, saying it was valuable for their knowledge. However, they noted that time constraints were a major barrier—they wanted shorter training sessions or more flexible formats that could fit into their busy schedules. This feedback is crucial because it shows that even good programs can fail if they’re too time-consuming for busy healthcare providers.

The study looked at other health measures beyond blood sugar, including weight, blood pressure, and cholesterol levels. None of these showed significant improvements in either intervention group compared to usual care. The study also measured behavioral changes like diet and exercise habits, but these also did not show significant differences between groups. This suggests that while the text messages kept people engaged, they weren’t strong enough to create lasting changes in health behaviors or physical health markers.

This study adds to growing research on digital health interventions for diabetes prevention. Previous studies have shown mixed results—some text message programs have helped with weight loss and behavior change, while others haven’t shown significant benefits. This study is consistent with the mixed findings in the field. It suggests that simple text messaging alone may not be enough to prevent diabetes, and that more intensive or personalized interventions might be needed. The positive patient engagement found in this study aligns with other research showing that digital tools can help keep people motivated, even if they don’t always lead to major health improvements.

Several important limitations should be considered. First, the study only lasted 6 months, which may not be long enough to see significant changes in blood sugar levels—diabetes prevention often requires longer-term changes. Second, the study didn’t measure whether people actually followed the lifestyle advice in the text messages or changed their behaviors. Third, the text messages were fairly generic despite being described as ‘personalized’—more truly personalized messages based on individual preferences might work better. Fourth, the study didn’t compare against other intensive interventions, so we don’t know if text messaging is less effective than other approaches. Finally, the study was conducted in Spain, so results may differ in other countries with different healthcare systems and populations.

The Bottom Line

If you have prediabetes, text message reminders about diet and exercise may help you stay motivated and engaged with your health (moderate confidence). However, text messages alone are unlikely to significantly lower your blood sugar levels. You should combine text message support with other proven strategies like working with a dietitian, exercising regularly, losing weight if needed, and regular doctor check-ups (high confidence). More intensive programs that include personal counseling or coaching may be more effective than text messages alone (moderate confidence).

This research is most relevant for people with prediabetes who want to prevent developing type 2 diabetes. It’s also important for doctors and healthcare systems considering whether to implement text message programs. People who are very busy and prefer simple reminders might find text messages helpful as part of a broader prevention plan. However, if you need more intensive support or have difficulty making lifestyle changes, you should seek additional help from healthcare professionals like dietitians or diabetes educators.

Don’t expect to see major improvements in blood sugar levels from text messages alone within 6 months. If you’re going to use text messages as part of your diabetes prevention plan, combine them with other lifestyle changes and plan for at least 6-12 months to see meaningful improvements in blood sugar control. Some people may notice improvements in motivation and engagement with their health sooner, within weeks.

Want to Apply This Research?

  • Track your HbA1c levels every 3 months (ask your doctor for this blood test) and record the results in your app. Also track weekly: number of days you exercised, servings of vegetables eaten, and glasses of water consumed. This gives you measurable goals beyond just receiving messages.
  • Set up daily reminders in your app to log one healthy behavior (like a 30-minute walk or eating a vegetable with lunch). When you receive text message tips, immediately log which ones you’ll try that day. This creates accountability and helps you actually implement the advice rather than just reading it.
  • Create a monthly dashboard showing your progress on exercise, diet, and weight. Compare your HbA1c results every 3 months to see if your lifestyle changes are actually lowering your blood sugar. If you’re not seeing improvements after 3 months, use the app to schedule a conversation with your doctor about more intensive support options like working with a dietitian or diabetes educator.

This research describes a clinical trial and should not be used as medical advice. If you have prediabetes or are at risk for type 2 diabetes, consult with your doctor or healthcare provider before starting any new prevention program. The findings show that text messages alone did not significantly improve blood sugar levels in this study. Any diabetes prevention plan should be developed with your healthcare team and may include diet changes, exercise, weight management, and regular monitoring. Individual results may vary based on your specific health situation, genetics, and ability to make lifestyle changes.