title: Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial.
abstract: BACKGROUND
  Type 2 diabetes can often be prevented by lifestyle modification; however, successful lifestyle intervention programmes are labour intensive. Mobile phone messaging is an inexpensive alternative way to deliver educational and motivational advice about lifestyle modification. We aimed to assess whether mobile phone messaging that encouraged lifestyle change could reduce incident type 2 diabetes in Indian Asian men with impaired glucose tolerance.
  
  
  METHODS
  We did a prospective, parallel-group, randomised controlled trial between Aug 10, 2009, and Nov 30, 2012, at ten sites in southeast India. Working Indian men (aged 35-55 years) with impaired glucose tolerance were randomly assigned (1:1) with a computer-generated randomisation sequence to a mobile phone messaging intervention or standard care (control group). Participants in the intervention group received frequent mobile phone messages compared with controls who received standard lifestyle modification advice at baseline only. Field staff and participants were, by necessity, not masked to study group assignment, but allocation was concealed from laboratory personnel as well as principal and co-investigators. The primary outcome was incidence of type 2 diabetes, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00819455.
  
  
  RESULTS
  We assessed 8741 participants for eligibility. 537 patients were randomly assigned to either the mobile phone messaging intervention (n=271) or standard care (n=266). The cumulative incidence of type 2 diabetes was lower in those who received mobile phone messages than in controls: 50 (18%) participants in the intervention group developed type 2 diabetes compared with 73 (27%) in the control group (hazard ratio 0·64, 95% CI 0·45-0·92; p=0·015). The number needed to treat to prevent one case of type 2 diabetes was 11 (95% CI 6-55). One patient in the control group died suddenly at the end of the first year. We recorded no other serious adverse events.
  
  
  CONCLUSIONS
  Mobile phone messaging is an effective and acceptable method to deliver advice and support towards lifestyle modification to prevent type 2 diabetes in men at high risk.
  
  
  BACKGROUND
  The UK India Education and Research Initiative, the World Diabetes Foundation.
authors.affiliation: India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India. Electronic address: ramachandran@vsnl.com.
authors.forename: Ambady
authors.initials: A
authors.lastname: Ramachandran
authors.affiliation: India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Chamukuttan
authors.initials: C
authors.lastname: Snehalatha
authors.affiliation: India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Jagannathan
authors.initials: J
authors.lastname: Ram
authors.affiliation: India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Sundaram
authors.initials: S
authors.lastname: Selvam
authors.affiliation: India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Mary
authors.initials: M
authors.lastname: Simon
authors.affiliation: India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Nanditha
authors.affiliation: India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Ananth Samith
authors.initials: AS
authors.lastname: Shetty
authors.affiliation: Faculty of Medicine, Imperial College, London, UK.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Godsland
authors.affiliation: Faculty of Medicine, Imperial College, London, UK.
authors.forename: Nish
authors.initials: N
authors.lastname: Chaturvedi
authors.affiliation: Faculty of Medicine, Imperial College, London, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Faculty of Medicine, Imperial College, London, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Oliver
authors.affiliation: Faculty of Engineering, Imperial College, London, UK.
authors.forename: Christofer
authors.initials: C
authors.lastname: Toumazou
authors.affiliation: Faculty of Medicine, Imperial College, London, UK.
authors.forename: K George
authors.initials: KG
authors.lastname: Alberti
authors.affiliation: Faculty of Medicine, Imperial College, London, UK.
authors.forename: Desmond G
authors.initials: DG
authors.lastname: Johnston
mesh_terms: D000328:Adult; D040421:Cell Phone; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000517:prevention & control*; D006266:Health Education / Q000379:methods*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D033181:Information Dissemination / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D016016:Proportional Hazards Models; D011446:Prospective Studies; D040242:Risk Reduction Behavior