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

Publication date: Jun 17, 2026

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. 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. 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. 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.

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