Implementation and Evaluation of an Automated Text Message–Based Diabetes Prevention Program for Adults With Pre-diabetes

Abstract

Background: Despite the efficacy of diabetes prevention programs, only an estimated 5% of people with pre-diabetes actually participate. Mobile health (mHealth) holds promise to engage patients with pre-diabetes into lifestyle modification programs by decreasing the referral burden, centralizing remote enrollment, removing the physical requirement of a brick-and-mortar location, lowering operating costs through automation, and reducing time and transportation barriers. Methods: Non-randomized implementation study enrolling patients with pre-diabetes from a large health care organization. Patients were exposed to a text message–based program combining live human coaching guidance and support with automated scheduled, interactive, data-driven, and on-demand messages. The primary analysis examined predicted weight outcomes at 6 and 12 months. Secondary outcomes included predicted changes in HbA1c and minutes of exercise at 6 and 12 months. Results: Of the 163 participants included in the primary analysis, participants had a mean predicted weight loss of 5.5% at six months ( P < .001) and of 4.3% at 12 months ( P < .001). We observed a decrease in predicted HbA1c from 6.1 at baseline to 5.8 at 6 and 12 months ( P < .001). Activity minutes were statistically similar from a baseline of 155.5 minutes to 146.0 minutes ( P = .567) and 142.1 minutes ( P = .522) at 6 and 12 months, respectively, for the overall cohort. Conclusions: In this real-world implementation of the myAgileLife Diabetes Prevention Program among patients with pre-diabetes, we observed significant decreases in weight and HbA1c at 6 and 12 months. mHealth may represent an effective and easily scalable potential solution to deliver impactful diabetes prevention curricula to large numbers of patients.