MANAGe-DM: novel nurse case management to improve diabetes outcomes in Black men recently released from incarceration

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Diabetes is a significant public health problem that affects 34 million individuals in the United States with substantial disparities in prevalence and outcomes by race and sex. A growing body of evidence highlights structural racism and increased social risk as factors which account for racial disparities in diabetes outcomes. Incarceration is a major social risk factor with significant overlap with populations most likely to experience poor diabetes outcomes. Black men are disproportionately incarcerated relative to their White counterparts. With longer sentences and aging of the prison population, more Black men with pre-existing diabetes are returning to their communities. However, to date, limited research exists on interventions which mitigate the negative impact of incarceration on diabetes care and outcomes. There is considerable evidence nurse case management (NCM) interventions improve diabetes outcomes; however, standard models do not account for the unique needs of formerly incarcerated Black men. Flexible models outside the traditional healthcare clinic setting have been successful in Black men with other chronic disease, such as hypertension. While there is a paucity of interventional research examining chronic disease outcomes for patients with recent release from incarceration, studies have underscored the need for basic needs navigation and healthcare system navigation during reentry. Thus, the focus of this career development grant will be to test the preliminary efficacy of a novel nurse case manager intervention, MANAGe-DM, comprised of three components: diabetes education/skills training, basic needs navigation, and health system navigation in improving glycemic control, blood pressure, LDL-cholesterol, self-care behaviors, and quality of life in Black men with poorly controlled type 2 diabetes released from prison in the prior year. During the completion of this grant, the applicant will complete training and gain expertise in the 1) implementation and oversite of randomized control trials and diabetes interventions, 2) understanding the influence of structural racism on health outcomes, 3) use of advanced statistical skills for interventional research, and 4) study of community-engaged research.