Closing the Hispanic/Latino engagement gap in diabetes prevention: feasibility of a community co-designed, participate-to-lead program.

BACKGROUND: Hispanic/Latino (H/L) adults show lower engagement and smaller weight-loss outcomes than non-Hispanic White (NHW) participants in the National Diabetes Prevention Program (NDPP), a gap driven by delivery rather than biological differences. PURPOSE: To evaluate the feasibility, engagement, and preliminary clinical outcomes of Paso a Paso, a community co-designed, culturally relevant diabetes prevention program for Spanish-speaking H/L adults, across two cohorts: instructor-trainees (Cohort 1) and community participants (Cohort 2). METHODS: Single-arm feasibility pilot guided by RE-AIM, EPIS, and ERIC frameworks. Cohort 1 (n = 18 H/L community leaders) completed 16 weekly in-person sessions; Cohort 2 (n = 30 at two sites) completed 13-15 weekly sessions, both led by a registered dietitian. Participants were classified into three engagement tiers: high-dose (≥50% sessions), low-dose community-connected (<50% but retained at the final session), and discontinued. Body mass index (BMI), waist circumference, and HbA1c were assessed at baseline and 4 months. RESULTS: Cohort 1 achieved 100% retention and a median attendance rate of 93.8% (range 31.2%-100.0%). Cohort 2 achieved 73% 4-month retention and a median attendance rate of 61.5% (range 0.0%-93.3%). Among 21 paired participants, mean % body weight change was -1.5% (SD, 2.3) and 81% achieved any weight reduction; participants with overweight and obesity, the primary target population, lost -1.7% (SD, 1.5) and -1.9% (SD, 2.6) respectively. CONCLUSIONS: Paso a Paso suggests feasibility, with engagement and retention exceeding NDPP benchmarks for H/L participants and preliminary, clinically meaningful weight reductions observed across the winter holiday season. These hypothesis-generating findings support advancement to a powered hybrid effectiveness-implementation trial.