Review Article Identifying risk and preventing progression to Type 2 diabetes in vulnerable and disadvantaged adults: a pragmatic review J. Taylor 1 , C. Cottrell 2 , H. Chatterton 3 , J. Hill 4 , R. Hughes 5 , C. Wohlgemuth 3 and R. I. G. Holt 6 1 School of Public Health, London Deanery, London, 2 Education for Health, Warwick, 3 National Institute for Health and Clinical Excellence, Manchester and London, 4 Birmingham Community Healthcare NHS Trust, Birmingham, 5 Peterborough and 6 Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, UK Accepted 17 September 2012 Abstract Aim To identify effective approaches to recognize diabetes risk and prevent progression to Type 2 diabetes in vulnerable groups, whose diabetes risk may be difficult to identify or manage. Methods UK-based interventions that assess diabetes risk and/or target known risk factors were identified through four main sources: submissions to two calls for evidence by the National Institute for Health and Clinical Excellence; local practice examples collected via a targeted email questionnaire; selected electronic databases; and a focused search of relevant websites. No restriction was placed on the study type or evaluation methods used. Key themes and sub-themes on outcomes, as well as facilitators and barriers to successful delivery, are reported. Results Twenty-four interventions met all inclusion criteria: 15 included a risk identification element and 14 included preventative activities. A range of risk identification tools were used to improve diagnosis of unmet diabetes-related health needs and raise awareness of diabetes risk factors. All preventative interventions focused on lifestyle change. No interventions monitored blood glucose as an outcome and only one reported improvements in baseline risk scores. Facilitators included tailored and flexible programme design, outreach delivery in familiar locations and effective inter- agency working. Barriers included literacy and language difficulties, transient participant populations, low prioritization of diabetes prevention and cost. Conclusions It is possible to engage successfully with high-risk adults in vulnerable groups to achieve positive health outcomes relevant to the prevention of diabetes. However, more robust evidence on longer-term outcomes is required to ensure that programmes are targeted and delivered appropriately. Diabet. Med. 30, 16–25 (2013) Introduction There is an established body of evidence describing the successful components of interventions to recognize diabetes risk and prevent progression to Type 2 diabetes in adults identified to be at high risk of developing the disease. Clinical trials have shown that the risk of progression to diabetes can be reduced by almost 60% through lifestyle interventions that target weight loss, increasing levels of physical activity and dietary improvements [1,2]. These findings have subse- quently been confirmed in pragmatic implementation trials in real-life settings [3–5]. However, little is known about the effectiveness of such interventions for adults whose increased risk of developing Type 2 diabetes is more challenging to identify or manage. This group of people come from a wide range of disadvantaged and vulnerable backgrounds; for example, those living in poverty and socially excluded communities (e.g. prisoners, travellers, homeless people), as well as those with learning disabilities or severe mental illness. Members of certain ethnic or faith groups also face a raised diabetes risk that may be difficult to recognize or problematic to treat in practice. The elevated risk of developing Type 2 diabetes in disadvantaged and vulnerable adults is well documented. For example, people in the lowest socio-economic groups are 2.5 times as likely, and black and minority ethnic groups up Correspondence to: Jayne Taylor. E-mail: jayne.taylor8@nhs.net 16 ª 2012 The Authors. Diabetic Medicine ª 2012 Diabetes UK DIABETICMedicine DOI: 10.1111/dme.12027