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

糖尿病是影响美国3400万人的重大公共卫生问题， 种族和性别在患病率和结果方面存在巨大差异。越来越多的证据表明， 结构性种族主义和社会风险增加是糖尿病结果中种族差异的因素。 监禁是一个主要的社会风险因素，与最有可能遭受监禁的人口有很大重叠。 糖尿病预后差。黑人男子与白色男子相比，被监禁的人数不成比例。 随着刑期的延长和监狱人口的老龄化，更多的黑人男性患有糖尿病， 回到他们的社区。然而，到目前为止，关于减轻疾病的干预措施的研究有限。 监禁对糖尿病护理和结果的负面影响。有相当多的证据表明， 糖尿病管理（NCM）干预措施改善了糖尿病结局;然而，标准模型并不能解释 以前被监禁的黑人的独特需求传统医疗诊所之外的灵活模式 在患有其他慢性疾病（如高血压）的黑人男性中取得了成功。虽然有一个 缺乏干预性研究，检查最近从癌症治疗中释放的患者的慢性疾病结局。 研究强调了基本需求导航和医疗保健系统导航的必要性 在重返大气层时因此，这一职业发展赠款的重点将是测试一个 一种新型的护士病例管理干预措施MANAGe-DM，包括三个组成部分：糖尿病 教育/技能培训、基本需求导航和卫生系统导航，以改善血糖控制， 血压、低密度脂蛋白胆固醇、自我保健行为和生活质量在黑人男性控制不良型 2糖尿病患者，前一年出狱。在完成这项资助期间，申请人将 完成培训并获得以下方面的专业知识：1）随机对照试验的实施和现场外， 糖尿病干预措施，2）了解结构性种族主义对健康结果的影响，3）使用 先进的统计技能，为干预性研究，和4）研究社区参与的研究。

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.