When planning local or national services to deliver evidence-based, quality-assured programmes where the availability of places is limited, prioritise people with an HbA1c of 44–47 mmol/mol (6.2–6.4%) or a fasting plasma glucose of 6.5-6.9 mmol/L or a fasting plasma glucose of 6.5 to 6.9 mmol/L.

Provide specially designed and quality-assured intensive lifestyle-change programmes for groups of people at high risk of developing type 2 diabetes.

Involve the target community (including community leaders) in planning the design and delivery of the programme to ensure it is sensitive and flexible to the needs, abilities and cultural or religious norms of the community. For example, the programme should offer practical learning opportunities, particularly for those who have difficulties with communication or literacy or whose first language is not English.

Ensure programmes are delivered by practitioners with relevant knowledge and skills who have received externally accredited training. Where relevant expertise is lacking, involve health professionals and specialists (such as dietitians and health psychologists) in the design and delivery of services.

Ensure programmes adopt a person-centred, empathy-building approach. This includes finding ways to help participants make changes by understanding their beliefs, needs and preferences. It also involves building their confidence and self efficacy over time.

Ensure programme components are delivered in a logical progression. For example, discussion of the risks and potential benefits of lifestyle change; exploration of someone's motivation to change; action planning; self monitoring and self regulation.

Ensure groups meet at least eight times over a period of 9 to 18 months. Participants should have at least 16 hours of contact time either within a group, on a one-to-one basis or using a mixture of both approaches.

Offer more intensive support at the start of the programme by delivering core sessions frequently (for example, weekly or fortnightly). Reduce the frequency of sessions over time to encourage more independent lifestyle management.

Allow time between sessions for participants to make changes to their lifestyle and to reflect on and learn from their experiences. Also allow time during sessions for them to share this learning with the group.

Deliver programmes in a range of venues such as workplaces, leisure, community and faith centres, and outpatient departments and clinics. Run them at different times, including during evenings and at weekends, to ensure they are as accessible as possible.

Accredited, certified technology-assisted type 2 diabetes prevention programmes should be considered as part of a standard menu of options for delivery.

Consider the use of technology-assisted type 2 diabetes prevention programmes, with culturally competent educational content, available in a range of languages, with interpretation services available for people whose first language is not English.

As part of the programme, offer referral to, or seek advice from, people with specialist training where necessary. For example, refer someone to a dietitian for assessment and specialist dietary advice if required.

Following the initial intervention, offer follow-up sessions at 3-month intervals usually up to 12–15 months, and thereafter at appropriate intervals according to clinical need. The aim is to reinforce behaviour change and to provide ongoing support. Larger group sizes may be feasible for these maintenance sessions, depending on service provision and individual needs.

Link the programmes with ongoing weight management and other prevention initiatives that help people to change their diet or become more physically active.

Consider onward referral to services such as community link workers where the individual has wider support needs.

Support patients with ongoing lifestyle changes by signposting to appropriate resources (see Sources of further information).