A 4‐week community‐implemented diabetes prevention program is associated with improved metabolic outcomes at 12 months after participation

AIMS: Small Steps for Big Changes (SSBC) is a 4-week, evidence-based diabetes prevention program delivered by non-medical personnel in community settings. This study explored changes in type 2 diabetes risk factors and health behaviours over 12 months following SSBC program completion. METHODS: A single-arm pragmatic trial with repeated measures was conducted in three urban locations in Canada and was delivered virtually during COVID-19. Participants were adults at risk of developing type 2 diabetes (HbA1c 39-46 mmol/mol[5.7-6.4%]). SSBC consists of 6 one-hour sessions involving behavioural counselling and exercise. The primary outcome was HbA1c at 12-month post-program. Secondary outcomes included weight, waist circumference, functional exercise capacity, diet and physical activity behaviour at 12-month post-program. RESULTS: Three hundred and eighty-nine individuals at risk of developing type 2 diabetes were enrolled (mean age = 58.8(8.7) years, 61% White, 68% women), with a 93% session attendance rate. Of 389 enrolled, 172 completed 12-month assessments, of whom 117 had HbA1c at baseline and the 12-month follow-up. At 12 months, participants had significant reductions in HbA1c (-1.91 mmol/mol; -0.19% [95% CI: -2.57, -1.36 mmol/mol; -0.25, -0.13%]), weight (-3.03 [-4.15, -1.93] kg), waist circumference (-4.07 [-5.27, -2.91] cm) and improved distance walked on the six-minute walk test (37.55 [28.58, 46.75] m). Favourable changes in diet and physical activity were also sustained at 12-month post-program. CONCLUSIONS: SSBC participation was associated with improvements in key diabetes risk factors at 12-month post-program. These findings suggest that brief, community-based, lay-led programs may have potential for supporting diabetes prevention.