Asif Chida and Srinath Sarang exemplify the challenges South Asians face in managing diabetes, highlighting the need for culturally tailored healthcare solutions to improve outcomes in this community.
Seventy-year-old Asif Chida has lived with diabetes for over 20 years. For most of that time, he adhered closely to his doctors’ recommendations: monitoring his diet, taking medications, and maintaining discipline. Yet, despite his efforts, his HbA1c—a three-month average of blood sugar levels used to assess diabetes control—continued to rise. By the summer of 2025, during a visit to the South Asian Heart Center at El Camino Health in Mountain View, his HbA1c had reached 10.8.
Asif enrolled in the Center’s Stop Diabetes Prevention Program, and just three months later, his HbA1c dropped to 7.2—the lowest level since his diagnosis. “For the first time,” he says, “I felt I was truly gaining control over my diabetes rather than allowing diabetes to control me.”
After two decades of struggling to manage his condition, Asif finally found a program that resonated with him as a South Asian man who enjoys South Asian cuisine, addressing health risks that mainstream healthcare often overlooks.
For South Asian immigrants like Asif, diabetes is not merely a disease of old age; it manifests earlier, progresses differently, and can lead to severe complications if not managed effectively. In the Bay Area, which boasts one of the largest South Asian populations in the United States, this reality is all too common. “South Asians have a significantly higher prevalence of prediabetes and diabetes than other U.S. ethnic groups,” notes Dr. Alka Kanaya, a Professor of Medicine at UCSF and principal investigator of the MASALA study.
Current American healthcare practices are not adequately designed to address the unique risks faced by South Asians. “Because South Asians are more prone to diabetes at younger ages and at lower weights, current screening practices may miss a proportion of those at risk,” explains Dr. Latha Palaniappan, Associate Dean for Research and Co-Founder of CARE, the Center for Asian Health Research and Education at Stanford University School of Medicine. She emphasizes that earlier detection is crucial; catching the disease before it worsens can significantly alter the aging process.
Srinath Sarang, 56, exemplifies the complexities of diabetes management within the South Asian community. A former sprint champion in India, he moved to the Bay Area in the early 1990s as a summer intern. Long hours spent working to pay off student loans led him to choose convenient fast food options, primarily McDonald’s. Over time, he gained weight and was diagnosed with prediabetes by the late 1990s, compounded by a family history of the disease.
“Managing diabetes is a challenge,” says Srinath. “It takes work to get there, but it works.” Through a program called Virta Health, he adopted a disciplined approach, walking four to eight miles daily and following a high-protein, low-carbohydrate diet. As a result, he lost 37 pounds, his HbA1c decreased from 7 to 5.7, and he was able to discontinue all medications. His blood pressure also returned to normal levels.
However, a significant life disruption derailed his routine, and he has been striving to regain his footing ever since. “The challenge with the lifestyle,” he reflects, “was the lack of Indian recipes, converting it to be Indian-friendly. It takes work to get there, but it works.”
Standard screening tools often fail to detect diabetes in South Asians due to their unique physiological characteristics. They exhibit higher insulin resistance and lower beta-cell function than other ethnic groups at similar body mass indices (BMIs). They also accumulate visceral fat at weights that would not typically raise alarms in other populations. Dr. Kanaya’s MASALA study has tracked cardiovascular and metabolic health among South Asians for two decades, revealing that the higher prevalence of diabetes cannot be fully explained by known risk factors.
While the American Diabetes Association recommends screening Asian Americans at a BMI of 23 kg/m²—lower than the standard 25—many primary care providers still apply the latter threshold. When South Asians are diagnosed, the dietary advice often does not align with their cultural foods. Patients are frequently advised to replace rice with whole wheat bread or to avoid ghee, leading many to abandon the recommendations altogether. Others, like Srinath, attempt to create their own solutions without culturally relevant guidance.
Asif’s experience at the South Asian Heart Center (SAHC) went beyond clinical improvements. “I learned to pay attention to what I eat, when I eat, where I eat, and how much I eat,” he shares. “This awareness transformed my relationship with food.”
SAHC’s approach emphasizes cultural relevance in dietary recommendations. Ashish Mathur, who helped develop the AIM to Prevent and Stop Diabetes programs at SAHC, explains, “Our approach is not to remove culture from the plate. We help participants make familiar meals more protective, helping them build small, sustainable habits that can change the course of their health.”
Founded in 2006, SAHC was established to address the disproportionate rates of heart disease and diabetes among South Asians in the Bay Area. The Center combines personalized clinical assessments with lifestyle coaching based on its M-E-D-S framework: meditation, exercise, diet, and sleep. The dietary mantra is straightforward: More Greens than Grains. Their nutrition plan includes a practical daily target of zero sweetened beverages, one fistful of fruit, two fistfuls of cooked vegetables, and twelve nuts.
Prajakta Waingankar, PhD, a nutritionist at SAHC, emphasizes the importance of honoring the foods that patients already love. “There is no single South Asian diet,” she states. “Our approach is always individualized.”
New patients often come in with high-grain, starchy diets low in protein and non-starchy vegetables, reflective of traditional South Asian cuisine. Waingankar’s plate method offers a visual guide: half a plate of non-starchy vegetables, one quarter lean protein, and one quarter whole grains or starchy foods. “This approach naturally lowers excess carbohydrates while still allowing people to enjoy the foods they grew up with,” she explains.
Among participants tracked over a year, 63 percent lost 5 percent or more of their body weight, 25 percent improved their HbA1c, and 62 percent improved their cholesterol ratios. The program also recorded a 98.7 percent event-free survival rate from cardiac events for participants tracked over seven to eight years. These outcomes align with broader research indicating that culturally appropriate diabetes health education can lead to significant improvements in health metrics.
The MASALA study highlights the importance of dietary patterns, revealing that traditional healthy foods—less fried, lower in fat, and rich in fresh fruits, vegetables, nuts, and legumes—are optimal for health. An ideal meal for a prediabetic South Asian patient might include stir-fried vegetables instead of heavy cream-based curries and moderation of rice rather than complete elimination.
Despite the success of programs like SAHC, challenges remain in scaling these initiatives to reach a broader audience. Financial and resource constraints often limit access to culturally tailored care, leaving many South Asians without adequate support. The Bay Area’s South Asian population is diverse, encompassing both affluent tech workers and working-class immigrant families, all of whom share elevated biological risks but may have different access to healthcare resources.
Dr. Palaniappan emphasizes the need for proactive screening reforms, suggesting that lowering the BMI threshold in practice and screening earlier could significantly improve outcomes. The MASALA study has already influenced guidelines to adjust diabetes screening criteria for Asian Americans, recognizing the unique risks associated with South Asian ancestry.
Asif Chida and Srinath Sarang illustrate the importance of early diagnosis and culturally informed guidance in managing diabetes. Their experiences underscore the need for systemic change in healthcare to better serve the South Asian community. Until then, being proactive and informed may be the best strategy for individuals navigating their health journeys.
This article was written with support from the Solutions Journalism Network.