A pragmatic and scalable strategy using mobile technology to promote sustained lifestyle changes to prevent Type 2 diabetes in India and the UK

2型糖尿病在发达国家和发展中国家都是一个主要的健康问题。最近的临床试验表明，在许多情况下，通过注重饮食和体育活动的生活方式干预可以预防2型糖尿病。由于成功的生活方式改变方案的密集性质和费用以及确定人口中高危人群的困难和费用，这些已知的好处在向广大人口转化方面受到阻碍。我们提出了一项随机对照试验（RCT），在印度和英国比较使用移动的电话技术与传统管理的干预，以诱导血糖调节受损患者的生活方式改变。在印度，风险人群将通过简单的印度糖尿病风险评分，然后测量高风险评分人群的HbA 1c来确定。在英国，高风险受试者将从NHS健康检查计划和初级保健的常规筛查中确定。NHS健康检查计划是英国最近推出的一项政府计划，提供给40-74岁的人。英国的招聘也将基于HbA 1c测量。基于移动的电话的干预将使用短消息服务（SMS或文本消息）来提供教育、治疗目标、建议、支持和激励。受试者将被邀请参加，一旦招募，将被随机分配到常规治疗组或SMS干预组。康复护理将包括一对一的30分钟的访谈，由研究小组进行，提供个性化的饮食和锻炼建议。这将通过标准化的书面材料和关于IGR和糖尿病的教育来补充。这将在研究开始时提供一次。干预组将接受同样的初次面谈，此外，每周将收到3次短信，内容包括教育、建议、支持和激励。这些短信将根据初次面谈时设定的个人目标进行个性化设置。生活方式的改变将通过体育活动和饮食方式实现。主要结局是进展为糖尿病，定义为HbA 1c，有或没有SMS干预。次要结果将是客观测量的体力活动、体重和其他心血管危险因素（血压、总胆固醇、高密度脂蛋白胆固醇和血清甘油三酯）的改善。该研究计划与英国和印度预防糖尿病和心血管疾病（CVD）的主要举措相兼容。

Type 2 diabetes is a major healthcare problem in the developed and developing world.Recent clinical trials have demonstrated that it may be prevented in many instances bylifestyle intervention focused on diet and physical activity. Translating these knownbenefits to the population at large has been hampered by the intensive nature andexpense of the successful lifestyle modification programmes and by the difficulties andexpense involved in ascertaining those in the population who are at high risk. Wepropose a randomised controlled trial (RCT) comparing intervention using mobile phonetechnology versus conventional management to induce lifestyle modification in peoplewith impaired glucose regulation in both India and the UK. In India people at risk will beascertained using simply the Indian Diabetes Risk Score followed by measurement ofHbA1c in those with high risk scores. In the UK, high risk subjects will be ascertainedfrom the NHS Health Check Scheme and from routine screening in primary care. TheNHS Health Check scheme is a recently introduced government scheme in Englandoffered to people aged 40-74 years. UK recruitment will also be based on HbA1cmeasurements. The mobile phone based intervention will use short messaging service(SMS or text messaging) to deliver education, treatment targets, advice, support andmotivation. Subjects will be invited to participate and, once recruited, will be randomisedto usual care or the SMS intervention group. Usual care will consist of a one-to-one 30minute interview, conducted by the research team, delivering personalised diet andexercise advice. This will be supplemented by standardised written material andeducation regarding IGR and diabetes. This will be delivered once at the beginning of thestudy. The intervention group will undergo the same initial interview and, in addition, willreceive 3 times weekly text messaging with education, advice, support and motivation.These messages will be personalised to individual targets set at the initial interview.Lifestyle modification will be achieved by physical activity and dietary means. Theprimary outcome will be progression to diabetes, as defined by HbA1c, with and withoutSMS intervention. Secondary outcomes will be improvements in objectively measuredphysical activity, body weight and other cardiovascular risk factors (blood pressure, totaland HDL cholesterol and serum triglycerides). The study programme is compatible withmajor initiatives in both the UK and India for the prevention of diabetes andcardiovascular disease (CVD).