Summary: In a pragmatic cluster-randomised trial in primary care, an SMS-based digital intervention for prediabetes (PREDIABETEXT), with or without clinician training, did not significantly improve HbA1c versus usual care, although patients valued the messages.
PICO Summary
| Element | Detail |
|---|---|
| Population | 365 patients with prediabetes across 58 primary-care professional clusters; 6-month, 3-arm pragmatic cluster RCT, Balearic Islands, Spain. |
| Intervention | Three personalised lifestyle SMS messages per week (group A), or the same plus web-based training for clinicians (group B). |
| Comparison | Usual care (control). |
| Outcome | At 6 months, intention-to-treat analysis showed no significant HbA1c reduction: group A β=-0.05 (95% CI -0.21 to 0.10; p=0.50), group B β=-0.04 (p=0.56). No substantial differences in secondary outcomes. Qualitative interviews were positive about the messages’ practicality. |
PREDIABETEXT: SMS for prediabetes
Cluster RCT · prediabetes · 6 months
An SMS lifestyle intervention for prediabetes, with or without clinician training, did not improve HbA1c versus usual care at 6 months. Engagement was high but did not translate into glycaemic benefit.
Expert Commentary
This is a well-conducted negative trial whose value lies in the lesson it teaches rather than the result it hoped for, and that lesson is that engagement does not equal efficacy. Patients read and appreciated the texts, yet HbA1c did not move, which is a pointed reminder that information delivery and good intentions are necessary but not sufficient for behaviour change in prediabetes. The honest interpretation is one of dose: the Diabetes Prevention Program achieved its large risk reduction through intensive structured coaching, and a light-touch stream of weekly messages is a far smaller intervention, perhaps below the threshold at which metabolic benefit becomes detectable. Two further points sharpen the reading, modern usual care already includes prediabetes alerts and lifestyle counselling, which raises the comparator and shrinks any incremental signal, and HbA1c in the prediabetic range changes slowly with high biological variability, so it may be an insensitive endpoint relative to weight or progression to diabetes. Can I use this with my patients? Yes, as guidance on where to invest. I would not rely on SMS programmes to change glycaemia, and would instead direct higher-risk patients to structured, intensive prevention programmes, using digital messaging as an adjunct to maintain contact rather than as a treatment in itself.
References
Mira-Martínez S, Malih N, Angullo-Martínez E, et al. A multifaceted digital intervention for the prevention of type 2 diabetes mellitus in primary care (PREDIABETEXT): cluster randomized trial. J Med Internet Res. 2025;27:e70981. doi:10.2196/70981