Understanding Artificial Pancreas Systems: Results from a 24-Month Trial

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Self-reported moderate physical activity increased substantially from a median of 80 to 1,440 MET-minutes per week. While this represents a large change within the study, the lack of a comparison group means we cannot be certain the text messages caused this increase. Effectiveness rated as Strong based on the magnitude of change observed, though confirmation in a controlled study is needed.

Moderate physical activity (MET-minutes/week)

Self-reported vigorous physical activity increased from a median of 0 to 2,880 MET-minutes per week. This represents a substantial increase in self-reported activity, though the single-arm design prevents us from knowing if the text messages were responsible for this change. Effectiveness rated as Strong based on the large observed change within this study.

Vigorous physical activity (MET-minutes/week)

Participants' confidence in their ability to exercise improved meaningfully from baseline to follow-up. This indicates participants felt more capable of engaging in physical activity after receiving the text messages. Effectiveness rated as Strong based on consistent improvement, though a controlled study is needed to establish causation.

Several barriers to physical activity decreased, including concerns about social influence, fear of injury, lack of skill, and extreme temperatures. Reductions across multiple barrier types suggest improved perceptions about the feasibility of being physically active. Effectiveness rated as Strong based on multiple improvements observed within this study.

SMS text messaging behavioral intervention (ActiveText@T2D)

This study adds to growing evidence that text message interventions are feasible and acceptable in Middle Eastern populations for diabetes care. Previous work in Oman, Egypt, Iraq, and Saudi Arabia has shown similar patient acceptance.

The reported increases in physical activity align with similar studies in the US. The retention rate compares well to other feasibility studies globally. Unlike some studies that measured blood sugar changes, this study did not assess clinical outcomes at follow-up. The 6-week intervention was briefer than many comparable studies (often 3-6 months). The one-way messaging differs from newer interactive approaches that allow two-way communication. This study's strength is its rigorous, culturally-tailored design and inclusion of healthcare professional perspectives.

Confidence is moderate because this study shows the intervention is feasible and acceptable. The study had good recruitment (84%) and retention (75%) rates, and participants were willing to engage with the text messages.

However, there are important limits. Without a comparison group, the reported increases in activity could be due to other factors. The study was small (52 people) and short (6 weeks). Physical activity relied on self-reports, which may not be accurate. Most participants were well-educated urban residents, so results may not apply to everyone.

Text messaging appears feasible and acceptable to Saudi adults with type 2 diabetes and their healthcare providers.

Participants reported increased physical activity and improved exercise confidence, though these findings need confirmation in a study with a comparison group.

The intervention revealed a gap in care—physical activity is not consistently discussed during diabetes consultations.

This study successfully shows that a culturally tailored text messaging program can be delivered to Saudi adults with type 2 diabetes with good participation and retention.

The evidence is strongest for feasibility—the intervention can be delivered as planned and people are willing to participate.

The increases in physical activity are promising but cannot be confidently attributed to the text messages without a comparison group.

The program fills an important need by providing physical activity guidance outside clinic visits, which both patients and providers recognized as lacking.

Participants received text messages in Arabic twice per week for 6 weeks, totaling 12 messages. Messages were designed to promote physical activity using behavior change techniques. Content addressed local barriers like high temperatures and cultural considerations specific to Saudi Arabia.

Messages provided information about health benefits, instructions on how to be active, and encouragement. They were one-way texts with no option for participants to reply or interact. Content was reviewed by experts and patients to ensure it was culturally appropriate.

SMS text messaging, mobile health intervention, behavioral intervention, physical activity promotion, diabetes self-management education, behavior change techniques, culturally tailored intervention

Blake H, Alsahli MJ, Chaplin WJ, Konstantinidis STh. The ActiveText@T2D text messaging behavioural intervention to increase physical activity in adults with type 2 diabetes: A prospective single-arm feasibility trial. PLOS Digit Health. 2025;4(7):e0000953. doi:10.1371/journal.pdig.0000953

The intervention was feasible to deliver and acceptable to participants and healthcare professionals. Recruitment and retention were strong, with 84% of eligible people joining and 75% completing the 3-month follow-up. All text messages were delivered successfully. Self-reported moderate physical activity increased from a median of 80 to 1,440 MET-minutes per week, and vigorous activity increased from 0 to 2,880 MET-minutes per week. Exercise confidence improved, and several barriers to physical activity decreased. Interviews revealed that text messages served as helpful reminders and highlighted that physical activity is rarely discussed during regular diabetes care visits.

No comparison group to show if texts caused changes

Physical activity was self-reported, not measured objectively

Most participants were urban and well-educated

Text messaging appears acceptable for promoting activity in Saudi adults with diabetes, but effectiveness is unclear.

No comparison group makes it hard to know if text messages caused the changes. Small sample size limits how much we can trust the results. Short study duration (6 weeks) and follow-up (3 months) doesn't tell us about long-term effects. Physical activity was self-reported rather than measured with devices. Most participants were well-educated, moderate-to-high income urban residents. Blood sugar and weight were not measured at the end of the study. Text messages were one-way only, with no personalization or interaction. Study was conducted in 2020, and technology has changed since then.

Physical activity → ↑ (self-reported increase)

Exercise confidence → ↑ (moderate improvement)

Barriers to activity → ↓ (reported decrease)

This study recruited adults with type 2 diabetes who owned mobile phones from diabetes clinics in Saudi Arabia. Participants received two text messages per week in Arabic for 6 weeks. The messages were designed using behavior change principles and culturally tailored through expert review and patient input.

Researchers measured physical activity at the start and 3 months later using questionnaires. They also measured exercise confidence and barriers to physical activity. Blood sugar and weight were taken from medical records at the start only. Interviews with 11 patients and 8 nurses explored how people felt about the intervention.

Text messaging may help increase physical activity in adults with type 2 diabetes

This study tested text messages designed to help Saudi adults with type 2 diabetes become more physically active. Participants received two text messages per week in Arabic for 6 weeks.

The study included 52 adults (average age 55 years) from diabetes clinics in Saudi Arabia. The texts were culturally tailored to address local barriers like high temperatures and cultural considerations.

Participants reported increased physical activity and felt more confident about exercising. However, this was a small study without a comparison group, so we can't be sure the text messages caused these changes. Physical activity was self-reported, not objectively measured.

Without a comparison group, the observed changes could be due to other factors like seasonal variation or simply being in a study.

The sample was small and mostly well-educated urban residents, so results may not apply to rural or lower-income populations in Saudi Arabia.

Physical activity was self-reported, which may overestimate actual activity levels, and blood sugar was not measured at the end of the study.

A study of 52 Saudi adults with type 2 diabetes receiving text messages for 6 weeks

Adults with type 2 diabetes in Saudi Arabia who own mobile phones

Adults with type 2 diabetes in Saudi Arabia, particularly those with mobile phone access and SMS capability. Findings may be most applicable to middle-aged to older adults (mean age 55 years), both male and female, from urban settings with moderate-to-high income and education levels. Generalizability to rural populations, lower literacy groups, or other cultural contexts remains to be established.

This study tested text messages designed to help Saudi adults with type 2 diabetes become more physically active. Participants received two text messages per week in Arabic for 6 weeks.
The study included 52 adults (average age 55 years) from diabetes clinics in Saudi Arabia. The texts were culturally tailored to address local barriers like high temperatures and cultural considerations.
Participants reported increased physical activity and felt more confident about exercising. However, this was a small study without a comparison group, so we can't be sure the text messages caused these changes. Physical activity was self-reported, not objectively measured.

Text messaging may help increase physical activity in adults with type 2 diabetes

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