JMIR Publications

ABSTRACT

Background:

To reach all 84.1 million US adults estimated to have prediabetes, lower-cost and less-burdensome alternatives to the National Diabetes Prevention Program (NDPP) appear needed. In a previous randomized controlled trial (RCT), we demonstrated efficacy of a 12-month text message support program called SMS4PreDM in individuals with prediabetes.

Objective:

Upon dissemination of SMS4PreDM in a safety net healthcare system, we evaluated implementation and effectiveness in a pragmatic study

Methods:

English- and Spanish-speaking patients with diabetes risks (e.g. A1c 5.7-6.4) were referred by their providers and offered NDPP classes and/or SMS4PreDM. This analysis focuses on the impact of SMS4PreDM on weight loss among 285 SMS4PreDM-only participants who began the yearlong intervention between October 2015 and April 2017, as compared to a usual-care control group of 1233 patients with diabetes risks who were identified from electronic health record (EHR) data during the same time period but not referred. Weight outcomes included mean time-related weight change and realization of either ≥3% weight loss or gain. Mixed linear models adjusted for age, gender, race, ethnicity, preferred language, and baseline weight. A secondary analysis stratified by language. We also assessed implementation factors, including retention and cost.

Results:

The intervention group realized time-related mean weight loss of 1.3 pounds (SE = 0.74), while the control group realized mean weight gain of 0.25 pounds (SE=0.59, p-value=0.004). Spanish-speaking SMS4PreDM participants (n=130) realized time-related mean weight loss of 1.11 pounds (SE = 1.22) compared with weight gain of 0.96 pounds (SE = 1.14) in Spanish-speaking controls (n=382, p-value <.0001). English-speaking intervention participants (n=155) did not achieve more time-related mean weight change (-0.89 pounds; SE = 0.93) than English-speaking controls (n=828; 0.31 pounds gained; SE=0.62, p-value = 0.143). While the intervention group overall did not reach the ≥3% weight loss goal more than control participants 19.0%(95% CI 14.8 – 23.9) vs 21.6%(95% CI 19.3 – 24.0), p-value=0.33, more controls gained ≥3% weight compared with intervention participants 27.3% (95% CI 24.9 – 29.9) vs 20.0% (95% CI 16.8 – 25.1) p-value=.011. SMS4PreDM delivery costs were $100.92 per participant.

Conclusions:

Results suggest that SMS4PreDM may not be sufficiently effective to serve as a population health strategy. Clinical Trial: This was a pragmatic investigation of a previous published RCT and not registered as a clinical trial