Effectiveness of Text Messaging Interventions on BMI Among Adults With Prediabetes: Systematic Review and...

Area of Science:

• Metabolic Health
• Mobile Health Interventions
• Public Health

Background:

• Prediabetes is a significant global health issue requiring scalable management solutions.
• Lifestyle modification is key, but effective delivery strategies are lacking.
• Short Message Service (SMS) text messaging shows potential for behavior change but its efficacy in prediabetes is unclear.

Purpose of the Study:

• To assess the effectiveness of SMS text message-delivered lifestyle programs on BMI in adults with prediabetes.
• Secondarily evaluate effects on weight, waist circumference, hemoglobin A1c (HbA1c), total cholesterol, and diabetes incidence.

Main Methods:

• A PRISMA-guided systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
• Searches included major databases (PubMed, MEDLINE, CINAHL, Embase, Web of Science, Cochrane Library) from April 2005 to March 2025.
• Data extraction and risk of bias assessment were performed by three independent reviewers, followed by random-effects meta-analyses.

Main Results:

• Seven RCTs (n=4632) met inclusion criteria; SMS messaging did not significantly impact BMI compared to standard care (MD -0.17 kg/m²).
• Secondary outcomes including weight, waist circumference, HbA1c, and total cholesterol also showed nonsignificant effects.
• Diabetes incidence was not significantly reduced (OR 0.84), with considerable heterogeneity and imprecision noted for HbA1c and diabetes incidence.

Conclusions:

• Lifestyle programs using SMS text messaging demonstrated no meaningful effect on BMI or metabolic outcomes in adults with prediabetes.
• Pooled estimates were near null, with significant uncertainty and heterogeneity for several endpoints.
• Future trials should investigate tailored, interactive SMS strategies with extended follow-up and adequate power to address variability.