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

Prediabetes is a growing global health concern. Lifestyle modification is the cornerstone of management, yet scalable delivery strategies are needed. SMS text messaging is a promising mobile health approach for behavior change, but its effectiveness for metabolic outcomes in prediabetes remains uncertain.

This study aims to evaluate the effectiveness of text message-delivered lifestyle programs for BMI among adults with prediabetes and, secondarily, for weight, waist circumference, hemoglobin A1c (HbA1c), total cholesterol, and diabetes incidence.

We conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review and meta-analysis of randomized controlled trials (searching the PubMed, MEDLINE, CINAHL, Embase, Web of Science, and the Cochrane Library databases; from April 2005 to March 2025). Three reviewers independently screened studies, extracted data, and assessed risk of bias (using the Cochrane Risk of Bias tool), and random-effects meta-analyses were performed.

In total, 7 randomized controlled trials (n=4632) met the inclusion criteria. SMS text messaging did not significantly affect BMI compared with standard care (mean difference [MD] -0.17 kg/m², 95% CI -0.85 to 0.25; I²=32%). Secondary outcomes were similarly nonsignificant: weight (MD -0.46 kg, 95% CI -1.74 to 0.83; I²=27%); waist circumference (MD -0.36 cm, 95% CI -1.09 to 0.36; I²=13%); HbA1c (MD -0.05%, 95% CI -0.17 to 0.07; I²=89%); total cholesterol (standardized MD -0.00, 95% CI -0.06 to 0.06; I²=0%); and diabetes incidence (odds ratio 0.84, 95% CI 0.63-1.12, I²=51%; n=3515 across 3 trials). Estimates were small and, for several outcomes, notably HbA1c and diabetes incidence, were imprecise and heterogeneous, indicating substantial between-study variability.

In adults with prediabetes, lifestyle programs incorporating SMS text messaging showed no meaningful effect on BMI or other metabolic outcomes; pooled estimates were near null with considerable uncertainty and heterogeneity for some end points. Variability in intervention design, dose, and tailoring likely contributed to these results. Future trials should extend follow-up, report body composition outcomes in addition to BMI, and test tailored, interactive, closed-loop SMS text messaging strategies with adequate power to resolve heterogeneous effects.