Equity and impact of social prescribing in type 2 diabetes prevention: cross-sectional and cohort study using national primary care data.

BACKGROUND: Social prescribing(SP) has expanded rapidly in English primary care since 2019 to support the prevention and management of long-term conditions. However,evidence on its equity of access and effectiveness for type 2 diabetes(T2D) prevention is limited. AIM: To examine the reach,equity of access,and potential impact of SP on T2D prevention among adults at high risk. Design&Setting.Observational study using routinely collected data from the Royal College of General Practitioners Research and Surveillance Centre, including 1,790 general practices in England(January 2019-November 2023). METHOD: Cross-sectional analyses using multivariable logistic regression examined factors associated with SP referral amongst adults at high risk of T2D.Cohort analyses estimated the association between SP referral and incident T2D, adjusting for baseline covariates. We used calendar-period-stratified Cox models to capture programme roll-out and COVID-19 changes.Exploratory time-since-index analyses tested whether effects varied over time. RESULTS: Among 2,326,400 adults at high-risk of T2D, 271,582(11.7%)developed T2D over a median 3.7 years.Referrals to SP increased 27-fold from 0.3% to 7.1% and were more common among women(aOR 1.42 [95%CI1.40-1.43]),individuals living in more deprived areas(aOR:1.89 [95%CI:1.86-1.93]), current smokers(1.71 [1.68-1.73]),people with obesity(1.19 [1.17-1.21]), depression/anxiety(2.52 [2.49-2.54]),and multimorbidity(1.45 [1.43-1.47]).By calendar year,SP was associated with increased risk in 2019(aHR 1.67 [1.20-2.32]) but became protective by 2023 (aHR 0.84 [0.79-0.89]).By follow-up,SP increased risk within 0-2 years post-referral(aHR 1.09 [1.04-1.15])but was protective after ≥3 years (aHR 0.88 [0.80-0.97]). CONCLUSION: SP reached those with greater health and social need. The protective association against T2D emerged as services matured post-COVID and with longer follow-up, potentially reflecting cumulative engagement, though activity data were unavailable.