Two randomized trials have tested community-based diabetes programs designed specifically for South Asian adults. One combined electronic screening alerts with community health worker education in New York City. The other tested a culturally adapted lifestyle intervention in the Chicago area and found it did not reduce cardiovascular risk factors more than written materials alone, though participants did improve their diet, activity and confidence. This page reports what each trial measured and what the results showed, so you can understand what community programs have and have not yet proven.
Why test programs for South Asian adults separately
South Asian adults aged 44 to 84 in the MASALA and MESA studies had a type 2 diabetes prevalence of 23%, compared with 6% in white adults, 18% in African American adults, 17% in Latino adults, and 13% in Chinese American adults [3]. That gap is large enough that a program designed for a general population may not fit the specific barriers, food patterns, family structures or health beliefs of South Asian communities. Testing a program built for this population is how we learn whether culturally adapted delivery changes the outcome.
The two trials documented here represent the named research on community programs with South Asian-specific design published in the sources available. Neither trial is a guarantee of what will work for you. Both are attempts to answer a real question: does a program built for this population work better than the standard approach.
The DREAM Initiative in New York City
DREAM is a randomized trial running across 20 primary care practices in Queens and Brooklyn, serving South Asian patients in New York City [1]. The program combines two tools: electronic health record alerts that flag patients for screening at a BMI of 23 or higher, and group education delivered by community health workers trained to teach about diabetes risk and prevention [1].
The screening threshold of 23 sits lower than the standard BMI of 25 used for general populations. That threshold comes from research showing that South Asian adults develop diabetes at lower BMI values than other groups. The American Diabetes Association recommends testing at a BMI of 23 or higher in individuals of Asian ancestry who have one or more additional risk factors [4].
The community health worker piece is the culturally adapted part. Instead of a clinician delivering the education, a health worker from the community leads group sessions. The idea is that someone who shares language, food knowledge and lived experience in the community can explain diabetes risk and prevention steps in a way that fits how people actually live.
The DREAM protocol describes the design and the intent [1]. Published outcome data on whether the program prevented diabetes are not yet available in the sources listed here. That means the trial is still running or the results have not yet been published in peer-reviewed journals you can access.
The SAHELI trial in Chicago
SAHELI tested a culturally adapted lifestyle intervention with 549 South Asian adults in the Chicago metropolitan area [2]. The program was designed to fit South Asian culture, food and family patterns, and it was delivered to groups of participants over a defined period.
The trial compared SAHELI to a control group that received written health education materials. Both groups were measured on cardiovascular risk factors: blood pressure, cholesterol and triglyceride levels, and other markers of heart disease risk [2].
The result was clear and honest: SAHELI was not more effective than the written materials for reducing cardiovascular risk factors [2]. Participants in the SAHELI group did not end the trial with lower blood pressure, better cholesterol or other measured improvements compared with the group that got written materials.
But the trial also measured behavior and confidence. Participants in SAHELI showed greater improvements in dietary quality, physical activity and self-efficacy, meaning confidence in their ability to make changes [2]. They ate better food and moved more. They believed more strongly that they could manage their health.
That gap between behavior and measured outcome is real and worth understanding. A program can shift what people do without shifting the clinical numbers in the timeframe of the trial. It can take months or years for changes in diet and activity to move the needle on blood pressure or cholesterol. Or the program may have worked on the behaviors that matter most, and the measured outcomes simply did not catch up in the study period.
How community programs fit into screening and prevention
About 115 million US adults have prediabetes, and most people who have it do not know. Prediabetes means your blood glucose is higher than normal but not high enough to be diagnosed as type 2 diabetes. An A1C of 5.7% to 6.4% is prediabetes; an A1C of 6.5% or higher is diabetes [4].
People with prediabetes have a high chance of developing type 2 diabetes within 5 to 10 years [5]. The Diabetes Prevention Program, a large trial, found that losing 5% to 7% of body weight lowered the chance of developing type 2 diabetes. That is the evidence behind every community program: small changes in weight, diet and activity can delay or prevent the disease.
A community program sits between screening and that weight loss goal. First, you get screened. If your A1C or fasting glucose is in the prediabetes range, or if you have risk factors and have not been tested, a program can help you make the changes that prevent diabetes. The program provides structure, education, group support and accountability.
The question DREAM and SAHELI were trying to answer is whether a program built for South Asian adults works better than a generic program or no program at all. SAHELI's answer was that the culturally adapted program did not reduce cardiovascular risk factors more than written materials. DREAM's answer is still being written.
Here is what the two trials tested and what they found:
| Trial | Location | What it tested | What it found |
|---|---|---|---|
| DREAM Initiative | 20 primary care practices in Queens and Brooklyn, New York City | Electronic health record alerts to screen at BMI 23 or higher plus community health worker group education [1] | Trial protocol published; outcome data on diabetes prevention not yet available in published sources |
| SAHELI | Chicago metropolitan area | Culturally adapted lifestyle intervention with 549 South Asian adults [2] | Not more effective than written health education materials for cardiovascular risk factor reduction, but associated with greater improvements in dietary quality, physical activity and self-efficacy [2] |
What to do next
If you are thinking about joining a community diabetes program:
- Ask your clinician whether you have been screened for prediabetes or type 2 diabetes. If not, ask for an A1C test or fasting glucose test.
- If your result is in the prediabetes range (A1C 5.7% to 6.4%), ask what diabetes prevention programs are available where you live, including Medicare-covered programs if you are eligible.
- Understand that a program's job is to help you lose 5% to 7% of your body weight and build habits around diet and activity. That is the evidence-based goal.
- Ask whether the program is culturally adapted for South Asian adults, and what that means in practice: language, food examples, family involvement, or other specifics.
- Know that a program can help you change behavior without changing your measured risk factors immediately. Changes in diet and activity take time to show up in blood pressure or cholesterol.
- Check the guides hub for articles on what actually changes diabetes risk and South Asian diabetes risk to understand the screening thresholds and risk factors that apply to you.
Sources
- DREAM Initiative trial protocol, PubMed Central, electronic health record alerts and community health worker education in New York City primary care, accessed 2026-08-06, https://pmc.ncbi.nlm.nih.gov/articles/PMC6868710/
- SAHELI randomized clinical trial, PubMed, culturally adapted lifestyle intervention in Chicago, accessed 2026-08-06, https://pubmed.ncbi.nlm.nih.gov/39259546/
- Kanaya and colleagues, MASALA and MESA diabetes prevalence, PubMed, type 2 diabetes prevalence in South Asian and other US populations aged 44 to 84, accessed 2026-08-06, https://pubmed.ncbi.nlm.nih.gov/24705613/
- American Diabetes Association, Diagnosis and Classification of Diabetes, Standards of Care in Diabetes 2026, screening thresholds and prediabetes definition, accessed 2026-08-06, https://diabetesjournals.org/care/article/49/Supplement_1/S27/163926/2-Diagnosis-and-Classification-of-Diabetes
- NIDDK, insulin resistance and prediabetes, risk of developing type 2 diabetes within 5 to 10 years, accessed 2026-08-06, https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance