Diabetes in the context of incarceration: A scoping review

Summary

Background

The burden of chronic conditions, like diabetes, is disproportionately carried by people facing social disadvantages (e.g., those with experiences of incarceration). A dearth of knowledge remains about this topic. We conducted a scoping review to determine the extent of literature about diabetes management and/or self-management in relation to incarceration.

Methods

We used the Arksey and O'Malley five stage process, recommendations by Levac et al., and the PRISMA Extension for Scoping Reviews Checklist. Core search terms for diabetes were combined using the Boolean operator AND with terms relevant to incarceration. We initially searched the following electronic academic databases on January 5, 2021, and then updated these searches on September 7, 2022: APA PsycInfo, CINAHL, Criminal Justice Abstracts, EMBASE, MEDLINE, Scopus, and SocINDEX. There were no restrictions on language, study design, quality, location, time, and sex or gender differences. We searched for research articles, conference proceedings, dissertations and theses, government documents, and organization documents. We then searched for other forms of literature using an electronic database (ProQuest Dissertations and Theses – Global), the internet search engine Google, and various corrections and diabetes websites in August 2021 and then updated these searches in September 2022. We also reviewed the reference lists of the final selected documents to identify additional literature.

Findings

The search from the seven databases identified 3076 records. The search from other sources (e.g., websites) identified an additional 1077 records. A total of 40 documents met our final inclusion criteria and were included in this review. The type of research conducted was primarily quantitative in nature. Clinic and education interventions were most commonly investigated. Clinical outcomes were often reported. Most guidelines were targeted at healthcare providers. Much of the literature originated from high-income countries, which may not be fully applicable for different contexts like low-income countries. Many interventions were associated with improved outcomes.

Interpretation

Administrators can use our findings to develop appropriate policies for this population. Tailored diabetes education for this population and healthcare providers may improve management practices. Our findings offer key insights for improving diabetes care and outcomes for this underserved population. Addressing the diabetes-specific health needs of these people may improve overall public health.

Funding

KD has received the O’Brien Institute for Public Health Postdoctoral Scholarship (University of Calgary), Cumming School of Medicine Postdoctoral Scholarship (University of Calgary), and the Libin Cardiovascular Institute's 2021 Person to Population Seed Grant (University of Calgary).

Research in context.

Evidence before this study

This scoping review examines the extent of literature that exists about diabetes management and/or self-management for adults serving time in correctional facilities and/or those recently released into the community. Prior to this study, there were scattered published research studies and program descriptions on organizational websites. No one had previously synthesized or collated the sum of the knowledge on this topic in an academic publication.

Added value of this study

Our review is the first of its kind that offers insight into the existing knowledge and research regarding diabetes management and/or self-management among this underserved population. We found 40 documents that are mostly quantitative research articles originating from high-income countries and which reported clinic and education interventions. Clinical outcomes like A1C were commonly reported. Most guidelines were targeted at healthcare providers.

Implications of all the available evidence

Many interventions reported in our review were associated with improved outcomes making a compelling case for further investigation. Administrators can use our findings to develop relevant policies and procedures with the goal of improving diabetes care and outcomes for this population. Tailored diabetes education for this population and healthcare providers may improve management and/or self-management.

Introduction

Non-communicable conditions, such as diabetes, are collectively responsible for 71% of all deaths worldwide.¹ The social determinants of health significantly impact the risk, management, and complications of diabetes.² The burden of chronic conditions like diabetes is disproportionately carried by underserved and socioeconomically disadvantaged populations like people with experiences of incarceration.³

It is estimated that more than 11.5 million people may be serving time within correctional facilities worldwide.⁴ Globally, these people experience worse health outcomes than the general public.^3,5 People in correctional facilities have limited food choices, restricted autonomy, tightly controlled physical activity,^6,7 and a lack of control over medications.⁸ These individuals often return to their communities with underlying physical and psychiatric co-morbidities, which may have been under-treated or mismanaged during incarceration.⁵ In spite of the above challenges, paradoxically, incarceration can provide an opportunity for people with diabetes to access quality health care⁹ and be better equipped for self-management upon release.¹⁰

This body of literature remains relatively sparse when compared to the vast amount of diabetes research undertaken with community-dwelling adults.¹¹ The existing knowledge about diabetes management/self-management in the context of incarceration has not been systematically searched, summarised, and synthesised. A scoping review is essential to understand the sum total of this literature including interventions and guidelines that have been implemented, their impact on various outcomes, and gaps in knowledge.

Methods

We undertook a scoping review. Our approach for undertaking and reporting this review was informed by the Arksey and O'Malley (2005) five stage process,¹² the recommendations by Levac et al.,¹³ and the PRISMA Extension for Scoping Reviews Checklist.¹⁴

Research question

What is the extent of literature that exists about diabetes management and/or self-management for adults serving time in correctional facilities and/or those recently released into the community?

Literature sources

We developed a systematic search strategy with an experienced health sciences librarian (DL) to identify relevant literature. Core search terms for diabetes, including: diabetes, “diabetic∗”, “blood sugar∗”, and “glycemic control∗” were combined using the Boolean operator AND with search terms like: “correctional cent∗,” “correctional facilit∗”, “correctional institution∗”, “detention cent∗”, “jail∗”, “penitentiar∗”, “prison∗”, “remand cent∗”, “criminal∗”, “inmate∗”, “offender∗”, “incarcerat∗”, “correctional health care∗”, and “correctional health service∗”. We searched the following electronic academic databases on January 5, 2021: APA PsycInfo, CINAHL, Criminal Justice Abstracts, EMBASE, MEDLINE, Scopus, and SocINDEX (Supplement A) and then updated the searches on September 7, 2022. Within these databases, we searched for research articles, conference proceedings, dissertation and theses, government documents, and organization documents. We then searched for other types of literature using an electronic database (ProQuest Dissertations and Theses – Global), the internet search engine Google (Supplement B), and various corrections and diabetes websites in August 2021 and updated these searches in September 2022. We reviewed the reference lists of the final selected documents to identify additional literature.

Literature selection

We undertook a two-stage screening process.¹² There were no restrictions on language, study design, quality, location, time, and sex or gender differences. For the first stage, two reviewers (KD and NJ) independently screened titles and abstracts in duplicate. During this stage, documents were only excluded if they did not pertain to detained/incarcerated or recently released people and the primary focus was not diabetes management and/or self-management. Any title/abstract that was deemed relevant by either reviewer was advanced to the second stage. If a title seemed relevant, yet there was no abstract, this article was advanced to the second stage. Abstracts in non-English languages were advanced to the second stage (i.e., documents in French were reviewed by NJ and DC).

During the second stage, two reviewers (KD and NJ) independently reviewed the full text documents selected from stage one in duplicate. The inclusion and exclusion criteria for full text review included:

Inclusion criteria

• •Focus on diabetes care, management and/or self-management, lifestyle and/or medication interventions for diabetes AND
• •Detained/incarcerated or recently released adults (18 years of age and above)

Exclusion criteria

• •No focus on diabetes care, management or self-management, lifestyle and/or medication interventions for diabetes
• •No focus on detained/incarcerated or recently released populations
• •Focus on diabetes prevention
• •Focus on descriptive parameters about diabetes rates or other outcomes
• •Not most recent Guideline or Position Statement by date of publication (supplemented by newest version by the same government/organization)

The reviewers (KD and NJ) discussed any disagreements during both stages. If agreement was not reached, a third reviewer (DC) made the final decision. Agreement between reviewers was calculated using the kappa statistic for both stages. Covidence software was used for literature screening.

Charting the data

Two reviewers (KD and NJ) developed the data extraction table, which was reviewed by the senior author (DC) and librarian (DL). KD guided NJ in conducting data extraction. KD then undertook verification of the extracted data. The senior author (DC) and librarian (DL) provided feedback on the final literature table (Table 1). The development and completion of this table allowed us to summarise and synthesise the data.

Table 1.

Literature table.

First Author/year ∗Report funding	Location	Organization (O) and/or Journal (J), Peer Review	Title	Objective	Type of literature and design	Type of intervention	Sampling	Type of results	Description of results	Implications/recommendations	Type of diabetes	Sex and/or gender
Research articles
Ahmed, 1998	Khartoum, Sudan	(J) Practical Diabetes International, Yes	Difficulties of Managing Diabetes Mellitus in a Sudanese Prison	To study diabetes care and outcomes among people with diabetes in a Sudanese prison.	Quantitative/Pilot study	Clinic	Population based	Clinical	Reduction in fasting blood glucose (avg 2.21 mmol/L reduction after 7 months). Diabetes complications detected. Initiation and intensification of medications.	People in prison should attend external diabetes clinics or hospital staff could regularly visit prisons to provide diabetes care.	1 and 2	Men (most)
Albertini, 2015	Meurthe-et-Moselle (Toul), France	(J) Éducation thérapeutique du patient, Yes	Diabetes in Prison: Establishment of a Therapeutic Education Program	To develop and test the feasibility of a therapeutic education program tailored to prison for people with diabetes.	Mixed methods/Pilot study	Education	Convenience	Clinical AND Patient Reported Outcomes	No significant improvements in glycated hemoglobin. Participants were all satisfied and insistent on the importance of support in the prison setting. Dietary aspect of program was not fully implemented due to limited food options.	Diabetes education programs adapted to the prison setting may improve patient quality of life and self-management during incarceration.	1 and 2	Men only
Aoki, 2004∗	Texas, USA	(J) Diabetes Care, Yes	Cost-Effectiveness Analysis of Telemedicine to Evaluate Diabetic Retinopathy in a Prison Population	To investigate the clinical and economic impact of teleophthalmology in evaluating diabetic retinopathy in people with type 2 diabetes in prison.	Quantitative/Markov decision model and Monte Carlo simulation	Telehealth	One case subject	Clinical AND Economic	Teleophthalmology generated higher Quality-Adjusted Life-Years ($16,514/18.73 QALYs for teleophthalmology and $17,590/18.58 QALYs for no teleophthalmology) and is cost effective if the number of people with diabetes in prison is above 500.	Teleophthalmology may lower the cost of care in prison and reduce blindness caused by diabetic retinopathy in people with type 2 diabetes.	2 only	1 man
Ball, 2011	California, USA	Correct Care (official magazine), Not stated	KOP Glucometers in Prison? It's Working Great in California	To evaluate a diabetes self-care program policy about glucometer use in prison.	Quantitative/Pilot study	Glucometers	Population based	Clinical AND Patient Reported Outcomes	A1C reduction (avg 0.41%), hypo/hyperglycemic events, and emergency department visits. High participant satisfaction with intervention.	Implementation of self-care glucometer programs may improve diabetes care and outcomes in prisons.	Type 1 stated	Male only
Barnes, 2013	Texas, USA	Corrections Today (official magazine), Yes	Diabetes Education: State and Pharmacy Partnership Goes Beyond Medication Treatment	To pilot a group education strategy for diabetes self-management in correctional facilities.	Quantitative/Pilot study	Education	Convenience	Clinical AND Patient Reported Outcomes	A1C reduction (avg 1.6%). Participants reported feeling empowered due to knowledge gained.	A structured diabetes self-management education program is essential to achieve positive health outcomes in correctional facilities.	1 and 2	Female only
Bingham, 2016	Arizona, USA	(J) Journal of the American Pharmacists Association, Yes	Federal Bureau of Prisons Clinical Pharmacy Program Improves Patient A1C	To implement a nationwide system of pharmacist-delivered patient care services via pharmacist clinicians working under the physician-pharmacist collaborative practice agreement.	Quantitative/Pre-test post-test	Clinic	Not Stated (126 people enrolled from 5 facilities typically most difficult-to-treat persons)	Clinical	A1C reduction. (Avg 2.3%)	Pharmacists are vital for improving patient health outcomes in the Federal Bureau of Prisons.	Not stated	Male and Female
Booles, 2011	UK (England, Scotland, Wales, and Northern Ireland)	(J) Journal of Diabetes Nursing, Yes	Survey on the Quality of Diabetes Care in Prison Settings Across the UK	To audit prisons in the UK to identify the expertise and knowledge of clinicians and recognize the strengths and weaknesses of care management strategies for people with diabetes.	Quantitative/Cross-sectional survey	N/A	Convenience	Diabetes care strategies	Results RE: availability of inpatient beds; register of people with diabetes; health screening; care responsibility; people with diabetes; types of professionals providing care; blood glucose monitoring; medication management; hypoglycemia management; and staff and patient education.	Recommendations RE: diabetes care policies and procedures; register of people with diabetes needed; standard screening; dietary assessment; review of patients like general/hospital practices; individualized blood glucose monitoring; retinal screening; standardize hypoglycemia management; define professional roles; staff training; and education.	1 and 2	Males (most) and Female
Davoust, 2016	Marseille, France	(J) International Journal of Clinical Pharmacy, Yes	The Impact of Medication-Focused Workshops in a Diabetes Educational Program in Jail: A Pilot Study	To assess the effectiveness of workshops about medication-related behaviors in a type 2 diabetes mellitus educational program in jail.	Quantitative/Prospective observational	Education	Convenience	Clinical AND Patient Reported Outcomes	A1C reduction (avg 1.2%). All participants satisfied with intervention. Learning outcome scores significantly improved post intervention. 70% of participants demonstrated adoption of healthy strategies during case studies (achievement transfer).	Pharmacists' involvement in type 2 diabetes educational program in jail is valuable for positive health outcomes.	2 only	Male only
Edwards, 2005	Colorado, USA	(J) Diabetes Spectrum, Yes	Managing Diabetes in Correctional Facilities	To highlight the challenges of implementing clinical practice recommendations for diabetes in correctional facilities.	Qualitative/Narrative observational study	N/A	Not Stated	Diabetes care barriers	Barriers RE: care delivery systems; prison culture; budget constraints; nursing staff recruitment and retention; nutrition; medication lines; exercise; appropriate security and disposal of sharps; work groups; canteen purchases; lock downs; transfers; offender issues; staff perceptions; and other health issues.	ADA standards for correctional facilities should be implemented. Training requirements needed for staff. Curriculum development needed by diabetes consultants. Nursing competencies needed for nursing staff. Collaboration needed between corrections healthcare professionals and diabetes consultants.	1 and 2	Unspecified
Firth, 2014∗	Oregon, USA	(J) Women's Health Issues, Yes	Female Inmates with Diabetes: Results from Changes in a Prison Food Environment	To assess the effects that changes in the food environment had on females with diabetes in prison.	Quantitative/Quasi-experimental	Diet adjustment	Population based	Clinical	A1C reduction (avg 0.04% per month) for exposed group. Changes in BMI depended on amount of time served. Cholesterol trends did not differ between exposure groups. Exposed participants purchased fewer calories from the commissary post intervention.	Prison commissary is concerning because most women supplement their diet with a high number of calories from purchased foods. Changing the food environment within a women's prison can improve glycemic control and thus, lower the cost of chronic disease management.	Not stated	Female only
Fox, 2014∗	New York, USA	(J) Journal of Health Care for the Poor and Underserved, Yes	Health Outcomes and Retention in Care Following Release from Prison for Patients of an Urban Post-Incarceration Transitions Clinic	To evaluate medical care delivery at an urban post- incarceration transitions clinic about timely access to medical care, health outcomes, and retention in care for people recently released from prison.	Quantitative/Retrospective cohort	Clinic	Population based	Clinical	Diabetes-related results: At 6 months, from 14 participants, 6 were retained in care and 2 had a goal A1C (A1C less than or equal to 7.0 occurring more than or equal to 180 days after the first visit).	Access to medical care is needed but not sufficient to control chronic health conditions. More interventions are needed for previously incarcerated people.	1 and 2	Male (most) and Female
Hunter-Buskey, 2015	North Carolina, USA	(J) Journal of Correctional Health Care, Yes	The Effect of Blood Glucose Self-Monitoring Among Inmates with Diabetes	To evaluate the effect of self-monitoring glucose meters on A1C levels.	Quantitative/Retrospective interrupted medical record review	Glucometers	Stratified random	Clinical	Overall, the difference between the baseline and follow-up A1C was −0.107 (not statistically significant). However, group 3 participants had the worst baseline A1C, yet showed reduced A1C post intervention.	Diabetes self-care in correctional facilities is important, but more research is needed in this area.	1, 2, other	Male only
Jameson, 2008	New York, USA	(J) Journal of Correctional Health Care, Yes	Use of Telemedicine to Improve Glycemic Management in Correctional Institutions	To use telemedicine to provide diabetes care to men with difficult-to-control diabetes within the New York State penal system.	Quantitative/Retrospective chart review	Telehealth	Purposeful	Clinical	Overall improvement in glycemic control for most participants. 9 participants reached A1C goal (<7%) with frequent tele-visits and longer follow up period.	The use of telemedicine is feasible and can help improve glycemic control. Further research is needed regarding novel ways to improve diabetes care in correctional facilities.	1 and 2	Male only
Kassar, 2017	New York, USA	(J) Telemedicine and e-Health, Yes	Use of Telemedicine for Management of Diabetes in Correctional Facilities	To use telemedicine to improve diabetes care for people with diabetes in correctional facilities.	Quantitative/Retrospective chart review	Telehealth	Convenience	Clinical	A1C reduction (avg 1.3%), blood pressure, and LDL levels.	Telemedicine may help improve diabetes care in correctional facilities.	1 and 2	Male only
Leivesley, 2009	Manchester, UK	(J) Journal of Diabetes Nursing, Yes	A Nurse-led Diabetes Clinic in a Prison Setting	To review nurse-led diabetes care.	Mixed Methods/Audit	Clinic	Population based	Clinical and Patient Reported Outcomes	A1C reduction. Average A1C reduction is 1% after 3 months of nurse led care and better individual results have been obtained. Participants provided positive verbal feedback regarding clinic.	Nurse-led diabetes clinics are a strength of diabetes care.	1 and 2	Male only
Lin, 2019	California, USA	(J) Journal of Pharmacy Practice, Yes	Impact of a Pharmacist-Led Diabetes Clinic in a Correctional Setting	To implement pilot program of a pharmacist-led diabetes clinic in a large inner-city jail.	Quantitative/Pre-test post-test	Clinic	Population based	Clinical	A1C reduction (avg 0.4%). Frequency of statin use increased by 50.4%.	Adding advanced practice pharmacists to assist with diabetes care may reduce healthcare gaps and improve care in correctional facilities.	2 only	Male only
Lin, 2022	California, USA	(J) Journal of Correctional Health Care, Yes	A Missing Piece of Diabetes Management: A Correctional Health Perspective	To evaluate type 1 diabetes management (A1C levels) during and between incarcerations.	Quantitative/Cross-sectional chart review	N/A	Population based	Clinical	At the first incarceration, initial mean A1C was 11.5% and fell to 10.0% during incarceration. Upon reincarceration (after >3 months in the community), mean A1C was 11.4%, which dropped to 10.3% over the course of the second incarceration.	Diabetes transition clinics can help minimize high morbidity and mortality and financial costs of uncontrolled type 1 diabetes.	1 only	Male only
Mills, 2014	Warrington, UK	(J) European Diabetes Nursing, Yes	A Prison Based Nurse-led Specialist Diabetes Service for Detained Individuals	To examine whether a nurse-led specialist diabetes service in prison can improve diabetes care by reducing A1C – thus lower hospital admissions for hypoglycemia and diabetic ketoacidosis and, in turn, lower UK National Health Service costs.	Quantitative/Pilot study	Clinic	Convenience	Clinical	A1C reduction (avg 1.4% after 1 year), hospital admissions, rate of failed attendance at outpatient clinic appointments, cancelled consultant outpatient clinic appointments, and hypoglycemic events.	A prison-based nurse-led specialist diabetes service can lower hospital admissions, the number of outpatient clinic appointments, and improve clinical outcomes leading to cost savings.	1 and 2	Men/male only
Minchón Hernando, 2009	Huelva, Spain	(J) Revista Española de Sanidad Penitenciaria (Spanish Journal of Prison Health), Yes	Health Education in Prisons: Assessment of an Experience with Diabetics	To provide people with diabetes training and basic information about diabetes in Huelva Prison.	Quantitative/Descriptive cross-sectional survey	Education	Convenience	Patient Reported Outcomes	Over 80% of participants successfully answered over 88% of the questions which assessed knowledge achieved. Participants were satisfied with intervention and reported interest in applying knowledge gained for future diabetes self-care.	The development of self-help groups for people with diabetes in prison may be possible. Enable people with diabetes in prison to become educators and counselors regarding diabetes care.	1 and 2	Men (most) and Women
Nagi, 2012	Wakefield, UK	(J) Diabetes and Primary Care, Yes	Diabetes Service Redesign in Wakefield HM High-Security Prison	To improve clinical outcomes by diabetes service redesign and review 18-month effect of this intervention in HM Prison Wakefield.	Quantitative/Pre-test post-test	Model of Care	Population based	Clinical AND Economic	A1C reduction (% of patients with A1C < 7.5 increased from 41.4% to 61.3%). Reduction in blood pressure and lipid levels. No transfers to hospital diabetes clinics. Little transfers to hospital for hypoglycemia. Participants reported a significant improvement in diabetes care. Staff felt more confident in supporting people with diabetes. Significant cost savings compared to previous model of care.	Specialist teams can work with prison staff and patients with diabetes to deliver proactive diabetes care with little planning and expansion of the infrastructure.	1 and 2	Men only
O'Laughlin, 2020	California, USA	(J) Journal of Correctional Health Care, Yes	The Complete Care Model and Glycemic Control in California State Prisons	To evaluate the impact of the Complete Care Model on glycemic control.	Quantitative/Longitudinal retrospective cohort	Model of Care	Population based	Clinical	No statistically significant change in A1C post intervention as compared to pre intervention.	Additional research and evaluation are needed regarding the integration of chronic care theory and the CCM.	Not stated	Male (most) and Female
Reagan, 2016	Connecticut, USA	(J) International Journal of Prisoner Health, Yes	Relationships of Illness Representation, Diabetes Knowledge, and Self-care Behavior to Glycemic Control in Incarcerated Persons with Diabetes	To examine relationships of self-care behavior, illness representation, and diabetes knowledge with A1C.	Quantitative/Cross-sectional survey	N/A	Convenience	Clinical AND Patient Reported Outcomes	Higher glycated hemoglobin levels were associated with lower personal control beliefs, higher self-report of diabetes understanding, and using insulin.	Enhancing diabetes personal control beliefs among people with diabetes in prison may lead to lower A1C. Highly structured environments like prisons may give some people with diabetes no motivation to improve diabetes control even if they understand what to do. More diabetes-related research is needed.	1 and 2	Male (most) and Female
Thomas, 2016∗	California, USA	(J) Health and Justice, Yes	Patients' Experiences Managing Cardiovascular Disease and Risk Factors in Prison	To explore how correctional systems support the development of patients' knowledge and skills for cardiovascular disease risk factors (CVD-RFs) self-management.	Qualitative/Grounded theory and constant comparative method	N/A	Purposeful	Patient Reported Experience	Four themes emerged about care in prison: (1) CVD-RFs are managed through acute rather than chronic care processes; (2) Prison providers' multiple correctional and medical roles can undermine patient-centered care; (3) Informal support systems can promote CVD-RF self-management education and skills; and (4) The trade-off between prisoner security and patient autonomy impacts self-management opportunities.	Interventions needed to engage peers, medical providers, care delivery systems, and correctional staff in developing effective self-management strategies for prisons.	1 and 2	Male (most) and Female
Todd, 2022∗	Connecticut, USA	(J) Journal of Forensic Nursing, Yes	Health Literacy, Cognitive Impairment, and Diabetes Knowledge Among Incarcerated Persons Transitioning to the Community: Considerations for Intervention Development	To evaluate the relationships of health literacy (HL), cognitive impairment (CI), and diabetes knowledge (DK) among incarcerated people transitioning to the community.	Quantitative/Correlational analyses (secondary analysis)	N/A	Participants from Reagan 2019	Patient Reported Outcomes	70% of participants screened positive for CI and had low DK, and 20% had marginal or inadequate HL. HL, CI, and DK were positively associated with each other. Controlling for race, age, and group (control/experimental), cognitive function had a significant direct effect on HL but, not on DK. There was a significant indirect effect of cognitive functioning on DK via HL.	Interventions focused on increasing HL or tailored to low HL in the presence of CI may be effective in increasing DK. Nurses should consider implementing literacy-tailored approaches and screening for CI before incarcerated people participate in educational programs.	1 and 2	Male only
Guidelines (Organization, Nursing)
American Diabetes Association, 2021	Virginia, USA	(O) American Diabetes Association (J) Diabetes Care, Yes	Diabetes Management in Detention Facilities	To provide general guidelines for diabetes care in detention facilities in the United States of America.	Organization Guidelines	N/A	N/A	N/A	N/A	People in detention facilities should receive diabetes care that meets national standards. A comprehensive and multidisciplinary approach can be effective.	Refers to 1, 2, and Gestational. Emphasizes identification of type as per intake screening	Unspecified
Cohen, 2007	New York, USA	(O) Southern Poverty Law Center, Not stated	Prisoner Diabetes Handbook: A Guide to Managing Diabetes - for Prisoners, by Prisoners	To help people in prison self-manage diabetes from the perspective of those who have served time with diabetes.	Organization Guidelines/Community-based participatory research	N/A	N/A	N/A	N/A	Guidelines RE: facts about diabetes; identifying diabetes, get serious about diabetes, managing diabetes, education, food and nutrition, improving diet, exercise and activity, medicines, monitoring, management during lockdowns, medical care, consultations with medical specialists, introduction to complications, acute and chronic complications, and legal rights to medical care.	1 and 2	Unspecified
Diabetes UK, 2017	London, UK	(O) Diabetes UK, Yes	Having Diabetes in Prison Advocacy Pack	To give patients information about how to manage diabetes and what diabetes care they should expect to receive in prisons.	Organization Guidelines	N/A	N/A	N/A	N/A	Guidelines RE: general information about diabetes; management in prisons; care expectations; health record viewing; what to do if unsatisfied with care; time limits; filing complaints; what to do if being discriminated against; sources of support; and information about Diabetes UK.	1 and 2	Unspecified
Diabetes UK, 2021	London, UK	(O) Diabetes UK, Yes	Having Diabetes in Prison A guide to prison healthcare for prisoners and their families	To give patients with diabetes who are 18 years of age and over information about prison healthcare.	Organization Guidelines	N/A	N/A	N/A	N/A	Guidelines RE: introduction to prison healthcare, diabetes diagnosis in prison, taking medications, diabetes care that should be provided and complaints process, health checks and support, why and how to report problems getting insulin, healthy diet, increasing physical activity, blood glucose technology, diabetes help prior to prison discharge, and Diabetes UK support and information.	1 and 2	Unspecified
Gill, 1992	Liverpool, UK	(O) British Diabetic Association (J) Diabetic Medicine Journal, Yes	Diabetes Care in British Prisons: Existing Problems and Potential Solutions	To present problems and propose recommendations for diabetes care in British prisons.	Organization Guidelines	N/A	N/A	N/A	N/A	Recommendations RE: multidisciplinary diabetes team; modern diabetes management strategies needed; dietary improvements; and education	Not stated	Unspecified
National Commission on Correctional Health Care, 2006	Illinois, USA	(J) Journal of Correctional Healthcare, Yes	Clinical Guideline for Correctional Facilities: Treatment of Diabetes in Adults in Correctional Institutions	To expand diabetes care guidelines from the ADA recommendations due to the challenges of providing services in correctional institutions.	Organization Guidelines	N/A	N/A	N/A	N/A	Guidelines RE: management overview, patient assessment upon entry into correctional system, follow up care, vaccinations, assessing therapeutic management, use of assessment to guide treatments, correctional Barriers, and quality improvement monitors.	1 and 2	Unspecified
Reagan, 2016∗	Connecticut, USA	(J) Journal for Evidence-Based Practice in Correctional Health, Yes	Rediscovery of Self-Care for Incarcerated Persons with Diabetes	To examine self-care for diabetes in the incarcerated population within the Rediscovery of Self-Care (RSC) framework.	Nursing Guidelines	N/A	N/A	N/A	N/A	Clinicians can use the RSC framework by decreasing vulnerabilities and promoting adaptation, self-direction, and the re-discovery of self-care to potentially improve diabetes-related and re-entry outcomes for incarcerated people.	Not Stated	Unspecified
Guidelines (Government)
California Corrections Health Care Services, 2021	California, USA	(O) California Corrections Health Care Services, Not stated	California Corrections Health Care Services Care Guide: Type 2 Diabetes	To provide care guidelines for Type 2 diabetes in 35 California Department of Corrections and Rehabilitation institutions.	Government Guidelines	N/A	N/A	N/A	N/A	Guidelines RE: goals, diagnostic criteria, treatment options, monitoring, clinical inertia, decision cycle for patient-centered glycemic management, hypertension management (from ADA), lipid management, preventative care, diabetic nephropathy, diabetic foot care, hypoglycemia management, gestational diabetes, and patient resources.	1 and 2	Male only
Federal Bureau of Prisons, 2012	Washington D.C., USA	(O) Federal Bureau of Prisons, Not stated	Management of Diabetes: Federal Bureau of Prisons Clinical Practice Guidelines	To provide recommendations for the medical management of diabetes among people in federal prisons.	Government Guidelines	N/A	N/A	N/A	N/A	Guidelines RE: classification and diagnosis; screening; prevention/delay of Type 2 diabetes; baseline evaluation and initial treatment plan; treatment of Type 1 and Type 2; insulin administration; blood glucose monitoring; gestational diabetes; complications management; periodic evaluations, and patient and healthcare provider resources.	1 and 2	Unspecified
Hipkins, 1994	Georgia, USA	(O) Georgia Department of Corrections, Not stated	Chronic Care Clinics: Protocols and Clinic Procedures	To outline protocols and procedures for chronic clinic cares in Georgia Department of Corrections facilities.	Government Guidelines	N/A	N/A	N/A	N/A	Diabetes mellitus clinic protocols and procedures provided including assessment flowsheets and patient education tools.	1 and 2	Unspecified
Conference proceedings
Llwellyn, 2019	Guildford, UK	(J) Diabetic Medicine, Yes	Improving Care for People in Prisons: The Surrey Multidisciplinary Team (MDT) Approach	To pilot a virtual MDT with community diabetes nurses, consultant diabetologist, prison nurses, and prison general practitioner.	Conference Proceeding/Quantitative Pilot study	Education AND Model of Care	Population based	Clinical	A1C reduction (avg 2.5% after 6 months). Diabetes nine–care processes including individualized care plans followed for each participant. All participants offered structured education and if feasible, gym prescription. 8 participants referred to community podiatry service. All participants had retinal screening. 2 participants started on GLP-1 therapy.	A coordinated MDT approach is crucial to ensure people with diabetes receive high quality care regardless of their incarceration status.	Type 1, Type 2, Pancreatic diabetes secondary to pancreatitis	Female only
Mangan, 2013	Worcester, UK	(J) Diabetic Medicine, Yes	The Challenge of Delivering the X-PERT Structured Educational Programme in a Male High Security Prison Regime	To deliver the X-PERT structured education program about developing knowledge and skills for self-managing diabetes and improving health outcomes in prison.	Conference Proceeding/Quantitative Pilot study	Education	Convenience	Clinical AND Patient Reported Outcomes	Reduction in BMI (pre 33.47 kg/m2, post 25.85 kg/m2). No significant changes in other data (levels of empowerment, blood pressure, A1C, and cholesterol).	(1) Further research is needed including understanding the needs of the prison regime, budgets, and segregation policies to inform implementation of X-PERT. (2) Identify opportunities for change in diet and regime without extra cost. (3) Tailor program materials to address participant literacy and comprehension issues.	Type 2	Unspecified
Reagan, 2016	Connecticut, USA	(J) Nursing Research, Yes	The Effect of Ethnicity and Time Incarcerated on the Relationship of Knowledge and Glycemic Control in Persons in Prison Living with T2 Diabetes	To evaluate that race/ethnicity and length of incarceration moderate the relationship between diabetes knowledge and glycemic control.	Conference Proceeding/Quantitative Cross-sectional survey (secondary analysis)	N/A	Convenience (from initial study Reagan 2016)	Clinical AND Patient Reported Outcomes	As Length of Incarceration increases so does the magnitude of the positive association between diabetes knowledge and A1C. The only exception is found among Hispanic persons.	Length of incarceration and Hispanic ethnicity moderate the association of diabetes knowledge and glycemic control. Length of incarceration and ethnic diversity needs to be considered in the development of diabetes self-management education interventions.	Type 2	Male
Reagan, 2019∗	Connecticut, USA	(J) Diabetes, Yes	The Feasibility and Acceptability of a Diabetes Survival Skills Intervention for Incarcerated Persons Transitioning to the Community	To examine the feasibility, acceptability, and preliminary effect of 6-week 1 h/week diabetes survival skills intervention on diabetes knowledge, distress, self-efficacy, and outcome expectancy for transitioning incarcerated males.	Conference Proceeding/Quantitative Non-Equivalent Control Group Design with Repeated Measures	Education	Not Stated	Patient Reported Outcomes	Some significant changes in diabetes knowledge within control and intervention groups. Improvement in diabetes-related distress and outcome expectancy in both groups. Participants conveyed acceptance of and enthusiasm for the intervention.	Information gathering strategies among males with diabetes in prison may increase diabetes knowledge. Education intervention is feasible and acceptable with a larger sample size and refined recruitment process.	1 and 2	Male only
Wallis, 2017	Dorset, UK	(J) Diabetes Technology and Therapeutics, Yes	No Escape: Benefits of Digital Retinal Screening in Prison	(1) To establish rates of diabetic retinopathy in the prison population from 2012 to 2016 and compare to the general population with diabetes in Dorset. (2) To determine if retinal screening in Dorset prisons is a cost-effective way of monitoring referable retinopathy not needing treatment.	Conference Proceeding/Quantitative Quasi-experimental	Telehealth	Not Stated	Clinical AND Economic	The prison population had a statistically higher rate of referable retinopathy (10.5%) compared to the general population (6%) in Dorset. The cost of transporting a person out of prison for a medical appointment is less than or equal to £300 and an outpatient appointment in the Hospital Eye Service is less than or equal to £120. Whereas, screening a person in prison costs less than or equal to £33.98.	Digital imaging is a cost-effective way of monitoring referable diabetic retinopathy not needing treatment.	Not stated	Male only
Dissertation
Williams, 2020	California, USA	(O) Walden University, Yes	The Complete Care Model: Improving Diabetic Patient Outcomes in Correctional Facilities	To evaluate the impact of a patient centered medical home-based model of healthcare within the California Correctional Health Care Services on diabetic prisoners.	Dissertation/Quantitative	Model of Care	Criterion	Clinical	A1C reduction (avg 0.24%). No significant reduction in LDL levels. Increase in referrals to specialty services.	The use of this model of care can be expanded to improve care and outcomes for people with diabetes in correctional facilities. More research is needed.	Type 2	Male only

Critical appraisal

KD and NJ used the Mixed Methods Appraisal Tool (MMAT)¹⁵ to critically appraise the research articles, conference proceedings, and dissertation. DC resolved points of conflict. KD and NJ developed a table demonstrating the results of this appraisal (Table 2).

Table 2.

Mixed methods appraisal table for Research Articles (RA), Conference Proceedings (CP), and Dissertation (D).

Ethics

Ethics approval was not needed to conduct this scoping review because it is based on existing literature in the public domain.

Role of the funding source

The funders did not have any role in the development, design, and undertaking of this scoping review. All authors had access to the data and were responsible for the decision to submit this scoping review for publication.

Results

The search from the seven databases identified 3076 records. The search from other sources (e.g., websites) identified an additional 1077 records. A total of 40 documents met our final inclusion criteria and were included in this review (Fig. 1 and Table 1). Cohen's Kappa scores were 0.89783 (first stage) and 0.88325 (second stage).

Fig. 1.

PRISMA flow diagram.

Of the 40 documents, most originated from the USA (n = 26) (Fig. 2). A single study originated from Sudan – the only low-income country identified in this review. The included literature was comprised of: research articles (n = 24), guidelines from organizations, governments, and nursing (n = 10), conference proceedings (n = 5), and a dissertation (n = 1). Details regarding types of diabetes, sex and/or gender, and implications of work and/or recommendations for diabetes care are provided in Table 1. Only authors of five research articles, one nursing guidelines, and one conference proceeding reported receiving research funding (Table 1).

Fig. 2.

Features of literature.

NJ and KD critically appraised the research articles, conference proceedings, and dissertation (Table 2). We identified variability regarding the completeness of outcome data, consideration of confounders, and intended administration of the intervention (Table 2). We selected ‘No’ if the outcome data were incomplete (e.g., participants dropped out). Confounding was rated as low if there is no confounding expected or, appropriate methods to control for confounders were used (e.g., statistical methods).¹⁵ We selected ‘No’ if authors did not directly identify the methods used to control for confounders. We selected ‘No’ or ‘Can't Tell’ if the authors failed to clearly identify the time of the administration of the intervention and if they indicated it was not administrated as planned. ‘Can't Tell’ was selected when more information was required to make a ‘Yes’ or ‘No’ decision (e.g., conference proceedings offered limited information).

The earliest publication identified is by Gill et al.¹⁶ in 1992 and the most recent is by Lin et al. in May 2022.¹⁷ Over time, we noted a slow increase in the number of publications, with a plateau more recently (Fig. 3).

Fig. 3.

Trends in publication over time.

Research articles

Almost all of the research studies were conducted in high-income countries. Twenty three of 24 research studies were peer reviewed and mostly used quantitative methods (n = 20). Population-based (n = 9) and convenience (n = 8) sampling were most common. Most authors included participants having any form or type of diabetes. Thirteen studies included only male/men whereas two studies only involved female/women participants. Eight studies had participants from any gender/sex yet, most participants were male/men. No author(s) specifically commented on the inclusion of people with non-binary or diverse gender identities.

Interventional studies

Of the 24 studies, 18 involved diabetes-related interventions like clinics, education, telehealth, models of care, glucometers, and diet adjustment (Fig. 4). These studies were primarily quantitative in nature other than two mixed method studies.

Fig. 4.

Types of interventions and results.

Clinic interventions

The study designs used to conduct this research included pilot studies, pretest – posttest, retrospective cohort, and one mixed methods study which was an audit. Of the six clinics, five focused on solely diabetes care provided by physicians,¹⁸ nurses,^19,20 or pharmacists,^21,22 and one focused on post-incarceration medical care, which included diabetes, provided by a multidisciplinary team.²³ Diverse facets of diabetes care were provided in these clinics such as, screening for diabetes complications,¹⁸ ordering and interpreting laboratory testing,^21,22 medication management,18, 19, 20, 21, 22 blood pressure and lipid management,¹⁹ encouragement of self-monitoring (e.g., blood glucose and food diaries),¹⁹ patient education,²¹ and referrals to other providers.^19,20,22 The Bronx Transitions Clinic multidisciplinary team provided post-incarceration care specifically, primary care, specialty care, and social/behavioural programs.²³

The implementation and evaluation of these clinics examined various outcomes including clinical endpoints. There was a reduction in A1C, ranging from 0.4% to 2.3% in clinics led by nurses^19,20 and pharmacists,^21,22 and an average decrease of 2.21 mmol/L fasting blood glucose levels after seven months in the physician-run clinic.¹⁸ Other clinical outcomes included increased statin use,²² reduction in hospital admissions and hypoglycemic events, and improved participation rates in outpatient appointments in a nursing led diabetes clinic.²⁰ At the Bronx Transitions Clinic, despite this intervention, only two of 14 participants achieved a goal A1C (<7.0%) at six months.²³

Education interventions

The study designs used to conduct this research included prospective observational, pilot studies, descriptive cross-sectional survey, and one mixed methods pilot study. Of the four education interventions, one focused solely on medication management²⁴ and three focused on various topics like diet, exercise, and diabetes complications.25, 26, 27 There were average reductions in A1C by 1.2%²⁴ and 1.6%.²⁶ Participants reported feeling empowered,²⁶ satisfied,^24,27 and supported and better prepared for returning to the community.²⁵ There were also objective indications of improved knowledge.^24,25,27

Telehealth interventions

The study designs used to conduct this research included a modeling study and two retrospective chart reviews. Of the three telehealth interventions, one focused on teleophthalmology,²⁸ and two utilised telemedicine for diabetes consultations.^29,30 The teleophthalmology intervention resulted in higher quality-adjusted life years and was found to be potentially cost effective.²⁸ Where endocrinologists^29,30 provided telehealth-facilitated diabetes consults, there was a reduction in A1C - the number of patients with the poorest glycemic control (A1C > 9%) was reduced by 40%²⁹ and there was an average decrease of 0.5% from the initial to final visit.³⁰ In Kassar's study, 20 participants were prescribed angiotensin converting-enzyme-inhibitors and angiotensin II receptor blockers in which 15 of them had a final blood pressure of less than 140/90  mmHg over a mean of 3.3 televisits.³⁰ Moreover, 17/20 participants with high low-density lipoprotein were treated with statins and 15 of them had improved lipid profiles upon follow up.³⁰

Model of care interventions

The study designs used to conduct this research included longitudinal retrospective cohort and pretest – posttest. There were two novel models of care found. California Correctional Health Care Services designed the Complete Care Model based on chronic care theory for state prisons.³¹ No statistically significant change in A1C was observed after implementation of this model. The Wakefield Diabetes Service Redesign was implemented in the UK's HM Prison Wakefield, which included consultations with a diabetologist and diabetes specialist nurse.³² This model of care entailed monthly sessions between these two providers including case note review, joint clinic, and prison staff education. Laboratory tests, diabetes complication screening assessments, and a diet clinic were implemented. The use of this model resulted in a higher proportion of patients experiencing positive clinical outcomes: proportion of patients with A1C < 7.5 or equivalent increased from 46.4% to 61.3%; proportion of patients whose last blood pressure was <140/80 mmHG increased from 48.8% to 58.3%; and proportion of patients whose total cholesterol was <5 mmol/L increased from 60.7% to 80.3%. There were also zero transfers to hospital diabetes clinics and very few transfers to hospital for hypoglycemia. Significant cost savings emerged; the pre-implementation diabetes care cost was £55,146 and post-implementation cost was £26,331.

Glucometer interventions

The study designs used to conduct this research included a pilot study and retrospective interrupted medical record review. We identified two interventions in which glucometers were provided to people serving time in correctional facilities.^6,33 There was an average 0.41% reduction in A1C three months into the California program though the author did not indicate statistical significance.³³ In the 12-month period before this pilot study, participants made ten visits due to hypo/hyperglycemic events; in the first three months after implementation, no further visits had been made – it was not clear whether these visits were to the internal healthcare unit or an external setting.³³ Diabetes-related emergency room visits also decreased and there was high participant satisfaction.³³ The difference between baseline and follow up A1C was not statistically significant in the Federal Bureau of Prisons program.⁶

Diet intervention

We identified one diet adjustment intervention from the USA, the study design was quasi-experimental.³⁴ This diet adjustment resulted in a small reduction in A1C per month and fewer purchased calories from the facility store for women exposed to the intervention. Cholesterol levels did not differ between women exposed and not exposed to the intervention.

Cross-sectional surveys and chart review studies

There were two cross-sectional surveys. Booles audited diabetes care in UK prisons using a cross-sectional survey, which resulted in the identification of diabetes care strategies.³⁵ Authors of a USA survey found that higher A1C levels were associated with lower personal control beliefs, higher self-report of diabetes understanding, and use of insulin.³⁶ Lin et al. conducted a cross-sectional chart review to conclude that A1C decreased during incarceration.¹⁷ Authors of a correlation analysis (secondary analysis) from the USA found that health literacy, cognitive impairment, and diabetes knowledge were positively associated with each other.³⁷

Qualitative studies

We identified two qualitative studies. Edwards conducted a narrative observational study to identify barriers to diabetes care in American correctional facilities.³⁸ Thomas et al. qualitatively explored how correctional systems support the development of patients' knowledge and skills for managing cardiovascular risk factors like diabetes using grounded theory methods.³⁹ These authors identified various patient perspectives regarding prison healthcare: (1) risk factors (e.g., diabetes) were managed through acute processes (e.g., triaging based on medical acuity) rather than a chronic care focus; (2) patients perceived that professionals undertook multiple correctional and medical roles that could undermine patient centred care; (3) informal support systems could enhance self-management; and (4) prison policies influenced patient autonomy and self-management.³⁹

Conference proceedings and dissertation

The conference proceedings originated from the UK (n = 3) and USA (n = 2), and all were peer reviewed (Table 1, Fig. 2, Fig. 3, Fig. 4). Four conference proceedings entailed primary research40, 41, 42, 43 and one focused on secondary analysis of data from a larger study.⁴⁴ All research was quantitative in nature with some interventions. One dissertation originated from the USA and was a quantitative study (Table 1, Fig. 2, Fig. 3, Fig. 4).⁴⁵

Guidelines

Three government guidelines were from the USA.46, 47, 48 Six organization guidelines were from the USA49, 50, 51 and UK.^16,52,53 One set of nursing guidelines focused on clinicians’ use of the Rediscovery of Self-Care model to improve diabetes-related and re-entry outcomes for incarcerated people.⁵⁴ Most guidelines were targeted at providers (n = 7)^16,46, 47, 48, 49, 50^,54 with three published for people living with diabetes.51, 52, 53 The Prisoner Diabetes Handbook is of particular interest as it has been developed by people with diabetes who served time.⁵¹

Discussion

We found 40 documents about diabetes management/self-management in the context of incarceration. Most documents are research articles (n = 24), followed by guidelines (n = 10), conference proceedings (n = 5), and a dissertation (n = 1). The type of research conducted was primarily quantitative in nature. Clinic and education interventions were most often reported. Most authors reported improvements in various outcomes (e.g., clinical like A1C). Healthcare providers were the target audience for the majority of guidelines. Our findings make way for various implications in the domains of research, clinical practice, administration, and education.

We found limited knowledge about this topic in both the formal published literature and in our search of informal documents. Other authors have also highlighted the lack of knowledge in this area.^11,55 Some research findings generated from non-incarcerated populations may not be applicable for people with experiences of incarceration.⁵⁶ Thus, further diabetes-related research is needed to understand how the incarceration experience impacts diabetes care (i.e., treatment) and outcomes inside and outside of correctional facilities.

One potential reason that most literature originated from the USA is that they have one of the highest rates of incarceration worldwide,⁴ hence researchers may be more likely to pursue this topic. The strong human rights legislation for incarcerated populations, philosophies of rehabilitation and reintegration into society, and mandated correctional healthcare policies may explain the fact that nearly all literature originated from high income countries.⁵⁷ Ako et al. found only nine documents examining the ethical aspects of conducting health research in prisons in low- and middle-income countries.⁵⁸ There is a dearth of health evidence for correctional facilities in these countries yet, it is required to inform healthcare services.⁵⁸ This is concerning in that most of the world's incarcerated populations are in these low- and middle-income countries.⁵⁸

Researchers in low- and middle-income countries can use our findings as a starting point for their research endeavors. However, knowledge from high-income countries may not be applicable for low- and middle-income countries due to different contexts. Ultimately, researchers in low- and middle-income countries should conduct investigations based on their context. Researchers in low- and middle-income countries may also benefit from joining international organizations (Worldwide Prison Health Research and Engagement Network) to connect with others in this field.⁵⁸

We also found there is a dire need for qualitative research to gain in-depth understanding of the experiences of people who are and have been incarcerated, and healthcare providers that care for this population. Qualitative studies can be used to explore and present peoples' attitudes, behaviors, beliefs, and experiences impacting personal perceptions of their health, healthcare seeking behaviors, and adherence to treatment.⁵⁹ Qualitative research can enable thorough and context-sensitive insights from people with experiences of incarceration.⁵⁶ Integrating peoples’ perspectives in the development of care delivery models is paramount for improving healthcare services and health outcomes.⁶⁰

We identified that the research designs used in this field were lower on the hierarchy of evidence (e.g., cross-sectional surveys, pilot studies).⁶¹ More robust research like experimental and randomised controlled trial designs are needed in this area of inquiry¹¹ to inform diabetes treatment and subsequently improve outcomes. Furthermore, very few authors reported on funding – suggesting that much of this research is unfunded or informally funded. Federal research funding in the USA for this population is small even compared to the National Institutes of Health investment in health disparities research⁶²; researchers in this area may not have many opportunities to find public funding. Funding bodies should consider increasing financial support for such topics, especially with the rising rates of incarceration. We also found several recent research-oriented conference proceedings. The dissemination of this work at professional conferences is promising, showing that some interventions are being formally evaluated.

The most common types of interventions reported in this review included diabetes clinics and diabetes education models. Aligning with our findings, other authors have reported similar outcomes in community-dwelling adults, including improved A1C where diabetes clinics have been led by a multidisciplinary team,⁶³ nursing,⁶⁴ and pharmacy.⁶⁵ We found that educational interventions generally resulted in improvements in various outcomes. Likewise, other authors have reported similar glycemic improvements in an at home education program for adults living with diabetes⁶⁶ and a community clinic program for adults living with type 2 diabetes.⁶⁷ Other authors have also demonstrated improvements related to interventions like telehealth,⁶⁸ novel models of care,⁶⁹ self-monitoring,⁷⁰ and dietary adjustment⁷¹ when applied in general populations.

Clearly, diabetes-related interventions are understudied for people with experiences of incarceration. We found that most interventions were associated with improvements in various outcomes, making a compelling case for more research and program development. These interventions require further investigation in different jurisdictions using robust research designs to demonstrate their effectiveness. The proven success of these interventions has implications for clinical practice (i.e., implementation into practice). Correctional healthcare providers can also develop effective diabetes care plans³⁶ including the integration of these interventions. Many of these interventions (e.g., education) could also be adapted to focus on diabetes prevention. We found that these interventions were often developed and implemented by multidisciplinary healthcare providers. Therefore, the involvement of multidisciplinary teams in clinical practice can enhance care for this population.

Finally, people returning into the community need ongoing diabetes care and support. Thus, efforts like transitional care clinics are essential.²³ Healthcare providers practicing in the community can ask about incarceration as a determinant of health when assessing clinical history⁵⁵ to help with delivering tailored diabetes treatment.

Administrators (i.e., leadership) of correctional facilities may find our findings useful when advocating for and developing diabetes-friendly policies and procedures. Moreover, administrators can assist by offering daily physical activity opportunities, appropriate diets, and access to diabetes care.⁵⁵ Corrections and healthcare leadership can also advocate to their government and funding bodies for increases in resources to improve the recruitment, retention, and training of healthcare providers in low- and middle-income⁷² and high-income countries. Various organizations and governments are prioritizing diabetes care for this population as evidenced by their guidelines – though all are based in higher-income countries. Such guidelines can provide administrators the evidence-based support needed to promote diabetes prevention and treatment for this population.

We found that most guidelines were targeted at healthcare providers. Therefore, there may be an unmet need for more patient-facing diabetes resources for people in correctional facilities and upon their return into the community. Healthcare providers and other professionals (e.g., correctional officers) who receive diabetes education tailored to the context of incarceration may improve their practices when working with this population. Healthcare providers in the community can also benefit from learning about how incarceration impacts diabetes to provide better care outside of correctional facilities.

This scoping review has some limitations. There was heterogeneity in the types of interventions implemented thus, we did not conduct a metanalysis. We used the MMAT to critically appraisal various documents based on our interpretation however, other readers may appraise differently. We used comprehensive search strategies to systematically summarise and synthesise existing knowledge though, we may have not identified all relevant literature.

Our review is the first of its kind about diabetes management/self-management in the context of incarceration. Further diabetes-related research is needed for all aspects of the incarceration experience from admission into correctional facilities until return into the community.¹¹ This research is needed in high-income and low-/middle-income countries to improve diabetes treatment and health outcomes. Our review highlights how novel diabetes-related interventions can potentially benefit this population especially when implemented in clinical practice. Addressing the health and diabetes specific needs of this population can improve overall public health.⁵

Contributors

KD conceived this scoping review. DL assisted in the methods. KD conducted the searches to identify the literature. KD and NJ undertook literature screening, data collection and extraction, analysis, and critical appraisal. KD drafted the initial manuscript, to which all authors contributed. KD, DL, and DC contributed to data verification. DC provided supervision throughout the review process. All authors (KD, NJ, DL, and DC) had access to the data, and were responsible for the decision to submit this scoping review for publication and approved the final version.

Data sharing statement

The data used in this scoping review are existing literature and publicly available.

Declaration of interests

The authors have no conflicts of interest to declare.