The post-trial analysis of the Indian SMS diabetes prevention study shows persistent beneficial effects of lifestyle intervention. (August 2018)

• Record Type: Journal Article
• Authors: Nanditha, Arun; Snehalatha, Chamukuttan; Raghavan, Arun; Vinitha, Ramachandran; Satheesh, Krishnamoorthy; Susairaj, Priscilla; Simon, Mary; Selvam, Sundaram; Ram, Jagannathan; Naveen Kumar, Addagarla P.; Godsland, Ian F.; Oliver, Nick; Johnston, Desmond G.; Ramachandran, Ambady
• Is Part Of: Diabetes research and clinical practice. Volume 142(2018)
• Page Start: 213
• Page End: 221
• Publication Date: 2018-08
• Subjects: Diabetes -- Follow up -- Lifestyle modification -- Oral glucose tolerance test -- Primary prevention; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2018.05.042
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: This is the first post-trial analysis of prevention of diabetes in Asian Indians. Lifestyle modification of 2 years in high risk persons prevented diabetes. This was achieved by frequent short messages sent through mobile phones. Present analysis showed sustained beneficial impact for an additional 3 years. A 30% reduction in diabetes incidence occurred at 5 years. Abstract: Aims: We had shown that mobile phone based text messaging was an effective tool to deliver lifestyle changes among Asian Indian men with a 36% relative risk reduction in incident diabetes over two years. The present analysis investigated whether beneficial effects of intervention on diabetes prevention persisted for an additional three years after withdrawal of active intervention. Methods: The primary two year randomized controlled trial (2010–2012) compared lifestyle changes with use of automated text messaging reminders in the intervention (n = 271) versus standard care advice (n = 266) at baseline. At the end of the study, both groups received additional advice on lifestyle changes by a trained dietician. Participants free of diabetes (n = 394) were invited three years later to ascertain the sustained effect of intervention. The primary outcome was incidence of type 2 diabetes. This trial is registered with ClinicalTrials.gov, number NCT02848547. Results: During the mean follow-up of 5 years, 346 out of 394 (87.8%) men were reviewed. Incidence of diabetes was reduced by 30% in the intervention group, with declining gap between-group differences over time (Kaplan-Meier analysis). Significant improvement in dietary adherence occurred in the intervention group at 2nd and 5th year follow up (trend χ 2 = 21.35, p < 0.0001). Cox regression analysis showed that the 5th year incidence of diabetes was significantly reduced in the intervention group. Higher body mass index and 2 h plasma glucose at 24 months increased the incidence of diabetes. Conclusions: Sustained reduction in incident diabetes was apparent after cessation of active lifestyle intervention. This was possibly associated with continuing practice of improved lifestyle.