Jaclynn Hawkins

Purpose of Review: Diabetes and suicide are intersecting public health concerns, yet evidence at this intersection remains sparse for Black males and especially Black sexual minority males (SMM). This focused narrative review synthesizes direct and adjacent evidence, with emphasis on diabetes-specific disparities, intersectional stress processes, and primary care implications. Recent Findings: The diabetes-suicide literature is heterogeneous, but consistently identifies depression, diabetes distress, treatment burden, complications, and access to insulin or other medications as clinically relevant pathways. For Black males, structural racism, economic inequity, health care discrimination, and constrained access to high-quality diabetes and mental health care may intensify these burdens. The most directly relevant study identified found more lifetime suicide attempts among African American adults with type 1 diabetes than controls, but did not report male-specific estimates. We identified no study estimating diabetes-related suicidal thoughts or behaviors specifically among Black SMM. Common tools such as the Patient Health Questionnaire-9, Diabetes Distress Scale, and Columbia-Suicide Severity Rating Scale have broad clinical support but have not been specifically validated in Black males with diabetes or Black SMM. Common tools such as the Patient Health Questionnaire-9, Diabetes Distress Scale, and Columbia-Suicide Severity Rating Scale have broad clinical support, but the literature identified in this review did not establish their population-specific validity among Black males with diabetes, including Black SMM. Summary: The central finding is an evidence gap, not proof of a multiplicative risk effect. Primary care clinicians should use culturally responsive psychosocial inquiry, direct suicide assessment when indicated, collaborative safety planning, and integrated behavioral health care while avoiding assumptions that screening tools perform equivalently across populations. Prospective, disaggregated research and population-specific measurement studies are urgently needed.

Background: Black men face disproportionately high rates of type 2 diabetes (T2D), yet are underrepresented in diabetes self-management support (DSMS) interventions. Peer-led DSMS (PLDSMS) shows promise for minoritized populations, but few programs target Black men specifically. Objective: This pilot study examined feasibility and preliminary effectiveness of a culturally adapted, PLDSMS intervention for Black men with T2D in Metro Detroit. Methods: We conducted a 15-month randomized pilot trial (N = 48) comparing PLDSMS plus DSMES to DSMES alone (enhanced usual care). PLDSMS included monthly peer-led virtual sessions for six months post-DSME, plus six months of optional support. Primary outcomes included HbA1c and perceived diabetes self-management (PDSMS). Secondary outcomes included diabetes distress and social support at baseline, 3, 9, and 15 months. Results: Participants (mean age=63 years) demonstrated successful recruitment (N = 60) and high retention (>80% at 15 months). No between-group differences in HbA1c emerged (p=0.32). Perceived self-management showed significant group-by-time interaction (p=0.03); the control group scored 5.36 points higher at 3 months (p=0.02), but differences were not sustained at 9 months (p=0.67). Diabetes distress and social support did not differ between groups, though provider-related distress declined significantly across both arms (B=-0.54, p=0.001). Conclusion: This pilot demonstrates feasibility of a PLDSMS program for Black men. Glycemic control remained stable, and although between-group differences in perceived self-management were not sustained over time, findings are consistent with the hypothesis that peer-led support may help sustain self-management gains as the initial benefits of DSME alone begin to wane. Future fully powered trials are needed to test this hypothesis.

Black adults experience diabetes complications and mortality in disproportionate rates in the United States, with barriers to care driven by factors such as limited access to quality healthcare, socioeconomic disparities, racial discrimination contributing to mistrust and health misperceptions, and social determinants of health such as food insecurity. Poor diabetes outcomes occur, in part due to insufficient access to novel diabetes medications and technologies, and low participation in diabetes management education programs. Within care teams across various healthcare settings, limited health literacy, and poor patient-provider communication, often influenced by implicit bias, further hinders effective diabetes management. Peer support, especially when integrated effectively into a multidisciplinary care team, is a promising approach to address these challenges. Peer supporters, individuals with shared lived experience and cultural backgrounds can foster trust, translate medical guidance in lay terms, and provide ongoing and sustained emotional, social, and tangible support. Peer-led interventions reduce diabetes distress and improve self-efficacy, medication adherence, and clinical outcomes, especially when tailored for Black adults. To effectively integrate peer supporters into care teams, defined roles, structured workflows, and strategically engaging them in patient care planning and team meetings is needed. Comprehensive and robust training, certifications, and continuing education ensure their competence, while maintaining role authenticity. Visibility within clinic and healthcare spaces, role clarity, administrative support, funding and continuous evaluation enhance the sustainability of peer supporters. Facilitators of their role include policy advocacy and funding avenues including Medicaid and Medicare reimbursements. Future efforts should focus on policy reforms to address structural inequities, support the expansion of peer supporters within care teams, including focused roles to thrive professionally, and establish sustainable models through participatory designs and robust evaluations. To address diabetes inequities in Black adults, culturally tailored peer support within multidisciplinary teams is critical, requiring collaborative engagement of healthcare systems, communities, and policy makers.

Purpose: Black men in the United States experience a disproportionate burden of cardiometabolic diseases, including type 2 diabetes (T2DM), hypertension, and cardiovascular disease (CVD). Despite these disparities, existing interventions often fail to address the shared risk factors, structural determinants, and implementation barriers that impact engagement and sustainability. This review applies implementation science frameworks to evaluate strategies for improving cardiometabolic interventions tailored to Black men. Recent Findings: Community-based interventions, culturally tailored health education programs, and peer-led models have demonstrated success in improving cardiometabolic outcomes for Black men. However, challenges such as medical mistrust, underrepresentation in research, and systemic barriers continue to limit their reach and sustainability. The Consolidated Framework for Implementation Research (CFIR) identifies multi-level barriers and facilitators, the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework assesses intervention impact, and the Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions (FRAME-IS) highlights equity-driven adaptations. Summary: Applying implementation science frameworks provides structured insights into optimizing interventions for Black men by addressing barriers across patient, provider, and system levels. Key facilitators include culturally relevant adaptations, an inclusive healthcare workforce, and trusted community partnerships. Future research should integrate equity-focused implementation strategies to improve adoption, engagement, and long-term sustainability of cardiometabolic interventions for Black men.

Purpose of Review: This scoping review aimed to identify implementation science (IS) research in pediatric diabetes, report integration of IS theory and terminology, and offer guidance for future research. Recent Findings: Of 23 papers identified, 19 were published since 2017 and 21 focused on type 1 diabetes. Most involved medical evidence-based practices (EBPs; n = 15), whereas fewer focused on psychosocial ( n = 7) and diabetes education ( n = 2). The majority either identified barriers and facilitators of implementing an EBP ( n = 11) or were implementation trials ( n = 11). Fewer studies documented gaps in EBP implementation in standard care ( n = 7) or development of implementation strategies ( n = 1). Five papers employed IS theories and two aimed to improve equity. Summary: There is a paucity of IS research in pediatric diabetes care literature. Few papers employed IS theory, used consistent IS terminology, or described IS strategies or outcomes. Guidance for future research to improve IS research in pediatric diabetes is offered.

Objectives There is a paucity of research focused on enhancing access to mental healthcare for older African Americans with type 2 diabetes (T2D), who may be at risk for or living with comorbid depression. This study aims to identify barriers and facilitators to mental healthcare utilisation among this population, guided by the theoretical domains framework (TDF). Design This qualitative study involved 30 interviews with older African American adults diagnosed with T2D. The interview questions were aligned with TDF domains to capture participant perspectives on barriers and facilitators to mental healthcare use. Setting Interviews were conducted via telephone by a licensed clinician trained in social work. Each session lasted 60–90 min and was transcribed and analysed. Participants The study included 30 African American adults (15 males and 15 females), aged 60 and above, living in an urban area in the Midwest. Primary and secondary outcomes The primary outcome was the identification of themes from participant responses, analysed using thematic content techniques and categorised into TDF constructs. Demographic data served as the secondary outcome. Results Nine key themes were identified, categorised under major TDF domains and constructs. Significant barriers included (1) systemic racism (‘knowledge’), (2) normalisation of depressive symptoms (‘beliefs about consequences’), (3) perceived stigma (‘beliefs about consequences’) and 4) costs of medications and healthcare (‘environmental context and resources’). Facilitators to seeking mental healthcare included (1) empowerment (‘beliefs about capabilities’), (2) perceived benefits of mental health exams (‘beliefs about consequences’), (3) positive provider experiences (‘reinforcement’), (4) recognition of depressive symptoms as a motivator (‘goals’) and (5) support networks (‘social influences’). Conclusion and implications Key findings highlight that fostering positive patient–provider relationships and enhancing self-recognition of depressive symptoms can significantly encourage mental healthcare utilisation among older African Americans with T2D. These findings suggest that future interventions should focus on strengthening these relationships and improving self-awareness to better mental health outcomes.

Background: High blood pressure (hypertension) disproportionately affects African American/Black (Black) women. Previous research suggests that self-managing hypertension may be challenging, yet mobile applications (apps) can help to empower patients and increase medication adherence. We developed questions to test the usability of evaluating the WHISE (Wellness, Hypertension, Information Sharing, Self-Management, Education) mobile app for Black women with hypertension. Methods: Fifteen participants completed usability testing; five were potential app users (Black women with hypertension); each invited two of their peers to participate. Each testing session (n=5) included a brief overview of the app, time for participants to complete surveys and have an active discussion about the app (concurrent and retrospective think-aloud, concurrent and retrospective probing, per usability.gov), and observation of participants’ body language during the session. Testing sessions were designed to familiarize participants with the app’s features and examine their navigating ability. Results: The app received overwhelmingly positive feedback, with 80% of participants finding it to be a valuable tool in hypertension management. Participants praised the app’s user-friendliness and educational value, with one stating, ‘It is a good educational piece for helping people manage hypertension, at least to understand its basics.’ Another participant highlighted the potential for community support, saying, ‘Having a community, having some people to be accountable, to check in with and see how things are going, could encourage and motivate people to be more diligent about managing their hypertension.’ Some participants also provided constructive feedback, suggesting font size adjustments (73%) and color scheme changes (60%) for certain screens. Conclusions: Based on the feedback we received, we were able to mitigate the participants’ concerns about font size and color and create tutorial videos to guide future users in using the app. We completed these changes prior to deploying the app in our randomized clinical controlled trial.