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.
