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

在发达国家和发展中国家，2型糖尿病是一个主要的医疗保健问题。最近的临床试验表明，在许多情况下，以饮食和体力活动为重点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，以及在确定人口中处于高危人群中的人所涉及的困难和费用，将这些已知的惠益转给广大人口一直受到阻碍。我们提出了一项随机对照试验(RCT)，比较在印度和英国使用移动电话技术的干预措施和传统管理方式，以诱导血糖调节受损的人改变生活方式。在印度，高危人群只需使用印度糖尿病风险评分，然后对高危人群进行糖化血红蛋白测量。在英国，高危对象将通过NHS健康检查计划和初级保健的常规筛查来确定。NHS健康检查计划是英国最近推出的一项政府计划，适用于40-74岁的人群。英国的招聘也将基于HbA1c的测量。基于手机的干预将使用短信服务(短信或短信)来传递教育、治疗目标、建议、支持和激励。受试者将被邀请参与，一旦被招募，将被随机分配到常规护理或短信干预组。通常的护理包括由研究团队进行的一对一30分钟的采访，提供个性化的饮食和锻炼建议。此外，还将提供标准化的书面材料和关于IGR和糖尿病的教育。这将在研究开始时提供一次。干预组将接受同样的初始访谈，此外，每周将收到3次短信，内容包括教育、建议、支持和激励。这些短信将根据最初访谈时设定的个人目标进行个性化。生活方式的改变将通过体育活动和饮食方式来实现。根据HbA1c的定义，无论有无短信干预，主要结果将是进展为糖尿病。次要结果将是客观测量的体力活动、体重和其他心血管风险因素(血压、总胆固醇和高密度脂蛋白胆固醇以及血清甘油三酯)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)的主要倡议相一致。

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).