An Integrated Electronic Health Record and Community Health Worker Intervention Shows Clinically Significant Weight Loss among South Asian Patients at Risk for Diabetes

Introduction: The DREAM Initiative is a two-arm randomized controlled trial (RCT) that analyzes the implementation and effectiveness of a community health worker (CHW) and electronic health record (EHR) intervention on weight loss promotion among South Asian Americans with prediabetes at primary care practices (PCPs) in New York City (NYC). Methods: Participants in the intervention arm received five group-based, in-langue education sessions and follow-up phone calls; the control group was matched via sex, age, and BMI using the EHR portal and not contacted. The primary outcome was proportion of those who achieved weight loss of ≥5% between baseline and 6-months. Secondary outcomes included hemoglobin A1c, systolic and diastolic blood pressure (BP), low density lipoprotein cholesterol (LDL-C), and behavioral outcomes measured at 6 and 12 months follow-up. Generalized linear mixed effects models assessed change across groups, adjusting for baseline weight, sex, and clustering by PCP. Results: A total of 952 individuals were randomized (476 per arm). Among treatment group participants, mean age was 48.3 years, 58% were female, all were born outside of the US, and mean years lived in the US was 11.3. In the treatment group, 87 out of 476 patients (18.3%) achieved 5% weight loss, compared to 27 out of 474 (5.7%) in the control group at 6 months (p<0.001). Mean weight in the treatment group decreased from 164.9 to 160.7 lbs., while in the control group, mean weight increased from 164.9. to 165.2 lbs. between baseline and 6-months (p<0.001). Secondary clinical outcomes will also be reported. Conclusions: Results from a highly powered RCT indicate that the DREAM Initiative intervention was statistically significant in helping South Asian Americans with diabetes achieve weight loss at PCPs in NYC. Future work will test the effectiveness and scalability of the intervention across multiple sites in the eastern United States. Disclosure S.Lim: None. L.Wyatt: None. H.Belli: None. S.Mammen: None. J.Zanowiak: None. S.Hussain: None. S.Mohaimin: None. N.Islam: None. Funding National Institutes of Health (R01DK110048)