The aim of this study is to develop and evaluate a low intensity, multifaceted, digital health intervention to prevent T2DM based on: i) the use of a system comprising mobile health (mHealth) technology integrated with electronic health records to send tailored text messages (SMSs) promoting lifestyle changes in people at risk of T2DM, and, ii) the provision of online education to primary healthcare workers about prediabetes management.
The PREDIABETEXT project will involve five WorkPackages (WP). In WP1-4 we will develop and pilot-test the different components of the intervention (WP1 will develop the brief text messages targeted to patients; WP2 will adapt our existing technology system to deliver the messages; WP3 will develop an educational intervention targeted to Primary Healthcare workers, and; WP4 will pilot-test and optimise both interventions). In WP5 we will conduct a phase II, six-month, three-arm, cluster randomised, clinical trial with 42 primary care workers and 420 patients at risk of T2DM (HbA1c from 6% to 6.4% or fasting plasma glucose 110-125mg/dl, or both) registered in Primary Care centres from Mallorca. Patients will be allocated to a control (usual care) group, intervention A (patient messaging intervention), or intervention B (patient messaging intervention plus online education to their primary healthcare workers). The primary outcome will be HbA1c. Secondary outcomes will include additional clinical outcomes, and physiological, behavioural and psychological outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
365
Participants will receive text messages (three per week) in their mobile phones during six months.
Primary healthcare workers will receive an online educacion about prediabetes. This intervention will aim at: 1) raising awareness about the importance of T2DM prevention; 2) increasing knowledge about effective strategies for diabetes prevention; 3) improving knowledge about brief counselling techniques; and, 4) enhancing communication skills.
Ignacio Ricci-Cabello
Palma de Mallorca, Balearic Islands, Spain
Change from Baseline Glycated Hemoglobin (HbA1C) at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline Fasting blood glucose at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline Triglycerides at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline Total Cholesterol at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline low density cholesterol (LDL) at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline high density cholesterol (HDL) at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline lipoprotein A at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline aspartate aminotransferase enzyme (AST) at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline alanine aminotransferase (ALT) at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline gamma glutamil transpeptidase (GGT) at 6 months
Time frame: Baseline and Postintervention (6 months)
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Change from Baseline complete hemogram at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline creatinine at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline serum albumin at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline insuline at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline urinary sediment at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline albumin-craetinine ratio at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline Body Weight at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline Waist Circumference at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline Blood Pressure at 6 months
Time frame: Baseline and Postintervention (6 months)
Change from Baseline of Cardiovascular disease risk at 6 months
Cardiovascular disease risk determined using the REGICOR calculator (www.imim.cat; Ramos et al., 2003)
Time frame: Baseline and Postintervention (6 months)
Diagnosis of T2DM
Time frame: Postintervention (6 months)
Brief motivation questionnaire (ad hoc)
On a scale from 0 to 7, this questionnaire meassures the level of motivation that participants present for following a healthy diet and a physical activity plan.
Time frame: Baseline and Postintervention (6 months)
14-point Mediterranean diet adherence screener (MEDAS-14)
Adherence to healthy diet. The score ranges from 0 to 14. A higher score corresponds to a higher adherence to Mediterranean diet. We will classify participants as low adherents (≤5), moderate adherents (6-9) or high adherents (≥10).
Time frame: Baseline and Postintervention (6 months)
REGICOR Short form Physical Activity Questionnaire
The questionnaire is a reliable and valid method to estimate moderate and vigorous intensity leisure time physical activity and sensitive to detect changes in moderate and vigorous intensity leisure time physical activity https://regicor.cat/aplicacions/activitat-fisica/
Time frame: Baseline and Postintervention (6 months)
Spanish version of the physical activity questionnaire used in the Physical activity questionnaire from the Nurses' Health Study
We will use the second part of the questionnaire, which studies sedentary behaviour. It includes questions about the number of hours spent in sedentary activities. Public Health Nutrition: 8(7), 920-927 https://nurseshealthstudy.org/
Time frame: Baseline and Postintervention (6 months)
Global Adult Tobbacco Survey: GATS questionnaire.
Tobbacco consumption. 3-items adapted from the GATS questionnaire (WHO).
Time frame: Baseline and Postintervention (6 months)
Quantification of alcohol consumption - FISTERRA
Calcultaion of alcohol consumption in Spanish Standard Drink units (10g per unit) per week. https://www.fisterra.com/herramientas/calcumed/
Time frame: Baseline and Postintervention (6 months)