- Design
- Cross-sectional and cohort analysis of national primary care records
- Population
- 2,326,400 adults at high risk of type 2 diabetes, >1,800 English practices
- Primary outcome
- Social prescribing referral and incident type 2 diabetes
- Effect
- aHR 1.67 (1.20–2.32) in 2019 vs 0.84 (0.79–0.89) in 2023; ≥3 years post-referral aHR 0.88 (0.80–0.97)
This observational study used records from more than 1,800 English practices on 2,326,400 adults at high risk of type 2 diabetes between 2019 and 2023. Over a median of 3.7 years, 11.7% developed diabetes.
Referral to social prescribing — link workers connecting patients to community activity, groups and support — rose from 0.3% to 2.5% of high-risk adults. It reached the people with most need: referral was more likely in deprived areas (aOR 1.89), with depression or anxiety (2.52), in smokers (1.71) and with multimorbidity (1.45).
The link with diabetes changed over time. Referral was associated with higher diabetes risk in 2019 (aHR 1.67) but lower risk by 2023 (aHR 0.84), and with lower risk three or more years after referral (aHR 0.88) but slightly higher within two years (aHR 1.09). The authors suggest programmes matured and engagement accumulated, but there were no data on what patients actually did. Early higher risk may simply reflect who was referred.
The India equivalent is less formal — ASHA workers, community groups, yoga and walking groups — but the principle of linking high-risk patients to sustained community activity is the same.
- For adults with prediabetes, consider linking them to local community activity or groups as well as giving lifestyle advice.
- Prioritise those with depression, anxiety or social deprivation, who are both higher risk and harder to reach.
- Expect any benefit to take years; review engagement at follow-up rather than judging at the first visit.
- Continue annual glucose testing in people referred to community programmes.
Why it matters
It suggests community linkage may support diabetes prevention, and that it reaches the people clinic advice often misses.
Don't overread it
Observational data without activity records cannot show social prescribing prevents diabetes.
The statistics, in plain English
Hazard ratios that flip from above to below 1.0 by year suggest the effect depends on how mature the service is, or on who was referred when. Without data on attendance, the study cannot separate the programme's effect from differences between patients.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for family medicine, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free