Mobile Text Messages Improve Diabetes, Heart Risk Control

Simple text reminders may help patients with type 2 diabetes (T2D) take control of their health, according to one study. A new clinical trial in China found that sending weekly mobile messages led to better management of blood sugar and blood pressure compared with usual care.¹

This randomized clinical trial is published in JAMA Network Open.

“In this 12-month multicenter randomized clinical trial, a mobile message–based intervention significantly but modestly reduced HbA_1c [hemoglobin A_1c] and SBP [systolic blood pressure] levels compared with usual care,” wrote the researchers of the study. “Mobile health interventions have gained much attention owing to affordability and ability to deliver health services, particularly in developing or low-income countries.”

Diabetes, especially T2D, significantly increases the risk of cardiovascular disease (CVD), even when blood sugar is well controlled.² People with diabetes often experience high blood pressure, abnormal cholesterol and triglyceride levels, obesity, and physical inactivity—all of which contribute to heart disease and stroke. Insulin resistance, common in T2D, is closely linked to these risk factors, amplifying the likelihood of CVD. Managing blood sugar, maintaining a healthy weight, staying active, and addressing other modifiable risks such as smoking are critical strategies for reducing cardiovascular complications in people with diabetes.

The trial enrolled 819 adults with uncontrolled T2D and comorbid cardiovascular risk factors from 5 clinical centers in China between November 2018 and March 2022.¹ Participants were randomly assigned to receive either usual care or a mobile message–based intervention for 12 months. The intervention group received 6 text messages per week, drawn from modules designed to remind, encourage, and motivate patients to engage in behaviors that support glycemic control and cardiovascular risk management.

Outcomes were assessed using the intention-to-treat principle, with primary endpoints including mean changes in hemoglobin A_1c (HbA_1c), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP). Secondary outcomes included the proportion of participants achieving HbA_1c control at 12 months.

Of the participants enrolled, 410 were randomized to the mobile message–based intervention and 409 to usual care. Over 12 months, the intervention group experienced significant reductions in HbA_1c (−2.8%; 95% CI, −2.9% to −2.6%), LDL-C (−11.1 mg/dL; 95% CI, −14.7 to −7.4 mg/dL), and SBP (−2.5 mm Hg; 95% CI, −3.9 to −1.2 mm Hg).

In the usual care group, reductions were −2.5% for HbA1c (95% CI, −2.7% to −2.3%), −11.9 mg/dL for LDL-C (95% CI, −15.8 to −8.0 mg/dL), and −0.1 mm Hg for SBP (95% CI, −1.6 to 1.3 mm Hg). The net differences between groups were −0.3% for HbA1c, 0.9 mg/dL for LDL-C, and −2.4 mm Hg for SBP, with a combined overall effect P value of .001. At 12 months, a higher proportion of participants in the intervention group achieved HbA_1c control compared with usual care (54.0% vs. 46.1%; P = .04).

However, the researchers acknowledged some limitations. First, the study focused on changes in risk factors rather than clinical outcomes and targeted only patient-initiated behavior. Additionally, self-reported measures may have been subject to bias, and data on health care utilization and cost-effectiveness were not assessed, limiting evaluation of the intervention’s broader impact.

Despite these limitations, the researchers believe the study highlights improvements in some cardiovascular risk factors in patients with T2D with the assistance of weekly mobile intervention.

“In this randomized clinical trial of adults with uncontrolled T2D in China, a mobile message–based intervention resulted in a modest improvement in HbA_1c levels and BP [blood pressure] among patients with uncontrolled T2D compared with usual care,” wrote the researchers. “These findings suggest that mobile message–based strategies for improving glycemic control and CVD risk factors should be considered for adults with T2D.”

References

1. Zhang P, Guo D, Liu C, et al. Mobile app–based intervention and cardiovascular risk factors in patients with uncontrolled type 2 diabetes: A randomized clinical trial. JAMA Netw Open. 2025;8(9):e2529762. doi:10.1001/jamanetworkopen.2025.29762

2. Cardiovascular disease and diabetes. American Heart Association. Last reviewed April 2, 2024. Accessed September 2, 2025. https://www.heart.org/en/health-topics/diabetes/diabetes-complications-and-risks/cardiovascular-disease--diabetes