Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jun 4, 2025
Date Accepted: Mar 19, 2026
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Effectiveness of Utilizing Text Messages on BMI among Prediabetes Adults. A systematic review and Meta-analysis
ABSTRACT
Background:
Prediabetes is a growing global health concern, associated with elevated risk of progression to type 2 diabetes and other complications. Lifestyle modification remains the cornerstone of prediabetes management, but scalable and accessible delivery strategies are needed. Text messaging represents a promising mobile Health (mHealth) approach for promoting behavior change; however, its effectiveness among individuals with prediabetes remains unclear.
Objective:
To evaluate the effectiveness of lifestyle modification programs utilizing text messaging on body mass index (BMI) among adults with prediabetes, compared with standard care, and to assess secondary outcomes including weight, waist circumference, HbA1c, total cholesterol, and diabetes incidence.
Methods:
A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines. Six electronic databases were searched for randomized controlled trials (RCTs) published between April 2005 and March 2025. Eligible studies included adults with prediabetes participating in lifestyle modification programs delivered via text messaging. Meta-analyses were performed using a random-effects model.
Results:
Seven RCTs involving 4,634 participants met the inclusion criteria. The pooled analysis showed no statistically significant effect of text messaging interventions on BMI (mean difference [MD] –0.17; 95% CI –0.85 to 0.25; P > .05) compared with standard care, with low heterogeneity (I² = 32%). Similarly, no significant differences were found in secondary outcomes including weight, waist circumference, HbA1c, total cholesterol, or diabetes incidence. Moderate to high heterogeneity was observed in some outcomes, particularly HbA1c and diabetes incidence.
Conclusions:
Lifestyle modification programs incorporating text messaging did not significantly improve BMI or metabolic outcomes among adults with prediabetes. Variability in intervention design, delivery, and content may have contributed to the inconsistent effects observed. Future research should focus on developing standardized, tailored, and interactive text messaging interventions with larger sample sizes and longer follow-up periods to optimize their effectiveness in diabetes prevention. Clinical Trial: PROSPERO registration number: CRD420251055972.
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