Helping communities act early on type 2 diabetes

Guest Author: Andy Timlett, Senior Inpatient Diabetes Specialist at University of Brighton

Reviewed by:  Matheus Abrantes, Gerald Cheruiyot

Why early action needs continuing support

Around 1 in 9 adults across the globe are living with diabetes. Among those with type 2 diabetes, up to half are already experiencing complications by the time they are diagnosed (International Diabetes Federation, n.d.). In terms of prevalence, alongside well-established risk factors such as diet, physical activity, obesity and environmental factors, the evidence suggests that certain ethnic minority populations and people on lower incomes are disproportionately affected by type 2 diabetes (Hill-Briggs et al., 2021). Additionally, more than three-quarters of adults living with diabetes reside in low- and middle-income countries (International Diabetes Federation, 2025) – meaning that many populations shoulder a substantial burden of diabetes. It is therefore clear that earlier action is needed to reduce the impact on people’s lives and healthcare services.

Diabetes UK (n.d.) estimates that 1 in 12 people in the UK are affected by ‘prediabetes’ – a condition where blood glucose levels and HbA1c are elevated, but not so high that a diagnosis of type 2 diabetes is given. This can be a powerful window of opportunity and an important point of recognition to help prevent the development of type 2 diabetes. The question, however, remains: after someone learns they are at risk of type 2 diabetes and its complications, what support exists to help them act on that information?

Each year, on 14 November, the International Diabetes Federation promotes World Diabetes Day to raise awareness of diabetes through a themed campaign highlighting particular areas of prevention, care and living with the condition. For 2026, the focus is ‘Early action on diabetes’. In 2002, the US Diabetes Prevention Program found a 58% lower incidence of type 2 diabetes with intensive lifestyle interventions (including dietary, activity and weight management support) compared with placebo, over nearly 3 years (Knowler et al., (2002). In a world of rising treatment costs, evidence from the US suggests that structured diabetes prevention programmes may help reduce healthcare spending (Kuo et al., 2025).

Dietary advice within everyday life

Often, when a person is told they are at risk of developing type 2 diabetes, they are told they need to change what they eat. Advice can feel inconsistent, unrealistic or too general to apply to everyday life. Healthy eating guidance is only one part of the puzzle. Putting that advice into practice may involve changing meals shared with a family, on a budget that is already stretched. The person receiving the advice may have little say in what is bought or cooked, and preparing separate meals may add expense and work to an already busy day.

Dietary advice therefore needs to account for how people live. The World Health Organization (2026) recognises that healthy diets vary according to cultural context, locally available foods and dietary customs. Familiar meals provide a useful starting point for discussing changes that a household could maintain.

The Kerala Diabetes Prevention Programme (K-DPP) considered these circumstances through local adaptation and family involvement (Mathews et al., 2017). Its approach offers an example of bringing prevention into everyday life. Peer support may provide opportunities to discuss the difficulties people encounter and share practical suggestions with others facing similar circumstances.

Community members gathered around food during a Mobile Teaching Kitchen activity. Source: Mobile Teaching Kitchen International (n.d.).

What peer support can contribute

Living with (or indeed being at risk of developing) diabetes reaches beyond an appointment. Having support from someone who understands those demands or is a trusted figure may help people make and sustain changes.

Someone may understand why they need to change their diet but struggle to find affordable alternatives to familiar meals. Talking with others facing similar difficulties may help them identify changes they feel able to try. Repeated contact also provides opportunities to return to those conversations, discuss setbacks and reconsider what is achievable.

The K-DPP offered 15 group sessions over 12 months, mostly delivered by trained lay peer leaders, combining lifestyle education with family involvement and community activities (Mathews et al., 2017; Aziz et al., 2018). Although reported fruit and vegetable intake improved, the trial did not demonstrate a statistically significant reduction in diabetes incidence at two years (Thankappan et al., 2018). These findings raise concerns about the programme as a whole; the independent contribution of peer support remains uncertain.

However, making support available does not ensure that everyone can use it. In Kerala, participants attended an average of eight of the 15 sessions. Among those who attended none, inconvenient timing and location were reported as barriers by 43% and 21%, respectively (Aziz et al., 2018). The organisation of support therefore deserves attention alongside its content. Session times, meeting places and the support available to facilitators all need consideration when developing a programme for a particular community.

Making early action possible

Whilst identifying people at increased risk is a crucial start to preventing type 2 diabetes, it is not enough in isolation. People and communities need support that is built on trusted relationships, but also sustainable and widely available. These communities should be involved at an early stage to help shape these programmes, including dietary approaches, venues, and timings. Lastly, the peer leaders these programmes depend on need to feel supported themselves, with appropriate training and resourcing so they can continue in the role.

References

Aziz, Z., Mathews, E., Absetz, P., Sathish, T., Oldroyd, J., Balachandran, S., Shetty, S.S., Thankappan, K.R. and Oldenburg, B. (2018) ‘A group-based lifestyle intervention for diabetes prevention in low- and middle-income country: implementation evaluation of the Kerala Diabetes Prevention Program’, Implementation Science, 13, article 97. Available at: https://doi.org/10.1186/s13012-018-0791-0.

Diabetes UK (n.d.) Prediabetes. Available at: https://www.diabetes.org.uk/about-diabetes/type-2-diabetes/prediabetes (Accessed: 30 October 2026).

Hill-Briggs, F., Adler, N.E., Berkowitz, S.A., Chin, M.H., Gary-Webb, T.L., Navas-Acien, A., Thornton, P.L. and Haire-Joshu, D. (2021) ‘Social determinants of health and diabetes: a scientific review’, Diabetes Care, 44(1), pp. 258–279. Available at: https://doi.org/10.2337/dci20-0053.

International Diabetes Federation (n.d.) World Diabetes Day. Available at: https://worlddiabetesday.org/ (Accessed: 30 October 2026).

International Diabetes Federation (2025) IDF Diabetes Atlas. 11th edn. Brussels: International Diabetes Federation. Available at: https://diabetesatlas.org/ (Accessed: 30 October 2026).

Knowler, W.C. et al. (2002) ‘Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin’, New England Journal of Medicine, 346(6), pp. 393–403. doi:10.1056/NEJMoa012512.

Kuo, S., Ye, W., Wang, D., McEwen, L.N., Villatoro Santos, C. and Herman, W.H. (2025) ‘Cost-effectiveness of the National Diabetes Prevention Program: a real-world, 2-year prospective study’, Diabetes Care, 48(7), pp. 1180–1188. Available at: https://doi.org/10.2337/dc24-1110.

Mathews, E., Thomas, E., Absetz, P., D’Esposito, F., Aziz, Z., Balachandran, S., Daivadanam, M., Thankappan, K.R. and Oldenburg, B. (2017) ‘Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP)’, BMC Public Health, 17, article 974. Available at: https://doi.org/10.1186/s12889-017-4986-0.

Mobile Teaching Kitchen International (n.d.) [Community members gathered around food] [Photograph]. Available at: https://static.wixstatic.com/media/957edb_71e30b35cca3432bbca559754c61b898~mv2.jpg (Accessed: 30 October 2026).

Thankappan, K.R. et al. (2018) ‘A peer-support lifestyle intervention for preventing type 2 diabetes in India: a cluster-randomized controlled trial of the Kerala Diabetes Prevention Program’, PLOS Medicine, 15(6), e1002575. Available at: https://doi.org/10.1371/journal.pmed.1002575.

World Health Organization (2026) Healthy diet. 26 January. Available at: https://www.who.int/news-room/fact-sheets/detail/healthy-diet (Accessed: 30 October 2026).