WhatsApp nudges linked to more steps in Delhi type 2 diabetes trial

A four-month mobile-health trial in India found that adults with type 2 diabetes who received personalized WhatsApp messages encouraging physical activity recorded a mean increase of 1,452.10 steps per day. Participants in the comparison group, which received conventional information, education and communication messages, recorded a mean increase of 319.84 steps per day. The intervention group also showed within-group reductions in random blood sugar and glycated hemoglobin after four months, while neither marker changed significantly in the control group.

The supplied results report changes within each group and do not provide a direct statistical comparison of the treatment effect between groups. The single-center, single-blind, parallel-group randomized controlled trial enrolled consecutive patients aged 30 to 59 years attending a non-communicable disease clinic at a rural secondary-care health facility in Delhi. The research was conducted over one year and included a four-month intervention.

The intervention consisted of tailored “nudge” messages sent through WhatsApp twice a week by the principal investigator. Patients in the control group received information, education and communication messages. Physical activity was measured using the Google Fit app installed on participants’ personal smartphones.

Random blood sugar and glycated hemoglobin, also known as HbA1c, were measured before and after the intervention. These measurements allowed the investigators to examine whether the physical-activity changes observed during the trial coincided with changes in glycemic control. The trial was prospectively registered in the Clinical Trial Registry of India on 11 September 2023 under the registration number CTRI/2023/09/057429.

After the intervention, the intervention group’s mean step count had risen by 39.3 percent, compared with an 8.3 percent increase in the control group. Among participants receiving the tailored WhatsApp nudges, random blood sugar declined by a mean of 15.64 mg/dL, with a reported p-value of 0.002. Mean HbA1c fell by 0.90 percentage points, with a reported p-value below 0.001.

The control group experienced no statistically significant change in either random blood sugar or HbA1c. These observations are compatible with the trial’s aim of using behavior-change communication to increase physical activity, but the reported blood-marker findings should not be interpreted as a formally tested between-group treatment effect because no such comparison is presented in the supplied results. The study offers a limited real-world test of personalized mobile messages as a means of encouraging physical activity among adults managing type 2 diabetes.

Its scope was restricted to one clinic in Delhi, a defined age range, a four-month intervention and the use of personal smartphones. They also do not show that the increases in steps or reductions in glycemia persisted after the intervention ended, or that the approach would produce similar results in other settings and clinical populations.

Subject of Research: Randomized trial of WhatsApp-based physical-activity nudges for adults with type 2 diabetes in Delhi, India

Article Title: m-Health intervention for physical activity among patients with type 2 diabetes mellitus in India: a randomized controlled trial

Article References: Shah, P. P., Bhatnagar, N., Banerjee, B., Rao, S., Singh, M., Yathagiri, N., & Ayushi, K. (2026). m-Health intervention for physical activity among patients with type 2 diabetes mellitus in India: a randomized controlled trial. BMC Public Health. https://doi.org/10.1186/s12889-026-29706-x

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29706-x

Keywords: type 2 diabetes, m-health, WhatsApp, physical activity, step counts, HbA1c, randomized controlled trial, India, Delhi, glycemic control, intervention, physical