SMS Text Messaging Lifestyle Programs Show No Significant Benefit for Prediabetes

This systematic review and meta-analysis evaluated the effectiveness of SMS text messaging-delivered lifestyle programs for adults with prediabetes. The study included 4632 participants across multiple trials, comparing SMS-based interventions to standard care. The primary outcome was BMI, with secondary outcomes including weight, waist circumference, hemoglobin A1c (HbA1c), total cholesterol, and diabetes incidence.

For the primary outcome of BMI, the meta-analysis found no significant effect, with a mean difference (MD) of -0.17 kg/m² (95% CI -0.85 to 0.25). Similarly, weight showed no significant reduction (MD -0.46 kg, 95% CI -1.74 to 0.83), and waist circumference was not significantly different (MD -0.36 cm, 95% CI -1.09 to 0.36). HbA1c also did not improve significantly (MD -0.05%, 95% CI -0.17 to 0.07), and total cholesterol showed no effect (standardized MD -0.00, 95% CI -0.06 to 0.06). For diabetes incidence, based on 3 trials with 3515 participants, the odds ratio was 0.84 (95% CI 0.63-1.12), indicating no statistically significant reduction.

Safety and tolerability data were not reported in the included studies, so no conclusions can be drawn regarding adverse events, serious adverse events, or discontinuations. The lack of safety information is a notable gap.

Compared to prior landmark studies of intensive lifestyle interventions (e.g., the Diabetes Prevention Program), which showed substantial benefits for weight loss and diabetes prevention, these SMS-based programs appear far less effective. The interventions in this meta-analysis were heterogeneous in design, dose, and tailoring, which may contribute to the null findings.

Key methodological limitations include small and imprecise estimates for several outcomes, substantial between-study variability, and considerable uncertainty and heterogeneity for endpoints such as HbA1c and diabetes incidence. The variability in intervention characteristics limits the ability to draw firm conclusions.

Clinically, these results suggest that SMS text messaging-delivered lifestyle programs, as currently designed, are unlikely to produce meaningful improvements in metabolic outcomes for adults with prediabetes. Clinicians should not rely on such interventions alone for diabetes prevention.

Remaining questions include whether more intensive or tailored SMS interventions, perhaps combined with other modalities, could be effective. The optimal dose, content, and duration of text messaging programs remain unknown. Future research should also report safety outcomes and explore patient subgroups that might benefit.