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

Sara Calderón-Larrañaga; Bernardo Meza-Torres; Simon de Lusignan; Rohini Mathur; Sarah Finer; Daniel Stow

doi:10.3399/BJGP.2025.0748

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Social prescribing for diabetes prevention: referral is only the beginning
Kinan Mokbel

Published on: 22 June 2026

Published on: (22 June 2026)
Page navigation anchor for Social prescribing for diabetes prevention: referral is only the beginning
Social prescribing for diabetes prevention: referral is only the beginning
Kinan Mokbel, Honorary Professor at Brunel University London, Senior Lecturer (Clinical Pharmacy, Advanced Clinical Practice, Pharmacology), University of Exeter
Calderón-Larrañaga and colleagues offer an important national analysis of social prescribing for people at high risk of type 2 diabetes. Referrals increased after national roll-out and were more common among people living in deprived areas, current smokers, people with obesity, multimorbidity and depression or anxiety.¹ In a prevention landscape where interventions can unintentionally favour those with more resources, this is reassuring.

However, interpretation of benefit needs care. Social prescribing is not a diabetes drug, and a referral code is not a dose of treatment. A referral may lead to a meaningful relationship with a link worker, welfare advice, food support, physical activity, debt help or reduced isolation. It may also lead to little where provision is limited, culturally mismatched, oversubscribed or difficult to access. So, the same code can describe very different experiences.

The study reports a delayed protective association with type 2 diabetes, emerging after services matured and follow-up lengthened.¹ This is plausible: social prescribing may work slowly by improving the conditions that make behaviour change possible. But I would treat it as a promising signal rather than proof of prevention. The authors acknowledge residual confounding, possible guarantee-time bias and the absence of information on participation, activity type, intensity or quality.¹

The equity message is mixed; Higher referral in d...
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Calderón-Larrañaga and colleagues offer an important national analysis of social prescribing for people at high risk of type 2 diabetes. Referrals increased after national roll-out and were more common among people living in deprived areas, current smokers, people with obesity, multimorbidity and depression or anxiety.¹ In a prevention landscape where interventions can unintentionally favour those with more resources, this is reassuring.

However, interpretation of benefit needs care. Social prescribing is not a diabetes drug, and a referral code is not a dose of treatment. A referral may lead to a meaningful relationship with a link worker, welfare advice, food support, physical activity, debt help or reduced isolation. It may also lead to little where provision is limited, culturally mismatched, oversubscribed or difficult to access. So, the same code can describe very different experiences.

The study reports a delayed protective association with type 2 diabetes, emerging after services matured and follow-up lengthened.¹ This is plausible: social prescribing may work slowly by improving the conditions that make behaviour change possible. But I would treat it as a promising signal rather than proof of prevention. The authors acknowledge residual confounding, possible guarantee-time bias and the absence of information on participation, activity type, intensity or quality.¹

The equity message is mixed; Higher referral in deprived areas is encouraging, but lower referral among Asian groups and younger adults is concerning given diabetes risk and potential lifetime benefit.¹ I believe attention should shift from referral counts to the pathway before and after referral: who is offered social prescribing, who accepts it, who can engage and whether the local offer is “actually” usable.

This caution is consistent with wider evidence. Realist work suggests that outcomes depend on link-worker roles, trust and local assets.² Other work also suggests benefit develops through steps rather than immediately after referral.³ Reviews show promise but remain cautious, with mixed and methodologically variable evidence,⁴ including diabetes-specific studies.⁵

Said that, this study is important because it shows reach into underserved groups. Still, the more important question is whether people received such practical support that helped address the everyday barriers contributing to their diabetes risk.

References

1. Calderón-Larrañaga S, Meza-Torres B, de Lusignan S, Mathur R, Finer S, Stow D. Equity and impact of social prescribing in type 2 diabetes prevention: cross-sectional and cohort study using national primary care data. Br J Gen Pract. 2026 Jun 1:BJGP.2025.0748. doi: 10.3399/BJGP.2025.0748.
2. Tierney S, Wong G, Roberts N, Boylan AM, Park S, Abrams R, Reeve J, Williams V, Mahtani KR. Supporting social prescribing in primary care by linking people to local assets: a realist review. BMC Med. 2020; 18(1):49. doi: 10.1186/s12916-020-1510-7.
3. Payne K, Walton E, Burton C. Steps to benefit from social prescription: a qualitative interview study. Br J Gen Pract. 2019; 70(690):e36-e44. doi: 10.3399/bjgp19X706865.
4. Pescheny JV, Randhawa G, Pappas Y. The impact of social prescribing services on service users: a systematic review of the evidence. Eur J Public Health. 2020; 30(4):664-673. doi: 10.1093/eurpub/ckz078.
5. Oliveira, D., Henriques, A., Nogueira, P. et al. Impact of social prescribing intervention on people with type 2 diabetes mellitus in a primary healthcare context: a systematic literature review of effectiveness. J Public Health (Berl.) 34: 801–829 (2026). doi: 10.1007/s10389-024-02315-x.
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Competing Interests: None declared.