Non-insulin-dependent diabetes mellitus (NIDDM) imposes a heavy burden on public health in the United States. This burden falls disproportionately upon Americans of African ancestry. The prevalence of NIDDM is over 50% greater in African-Americans than in whites, and African-Americans are at even higher risk for severe diabetic complications including end-stage renal disease and lower extremity amputation. Possible causes of this excess risk in African Americans include inadequate access to optimal primary health care and suboptimal health behaviors. We are therefore conducting a randomized, controlled trial to test two primary-care-based interventions to reduce risk in diabetic African-Americans: 1) a community outreach intervention and 2) a nurse case-manager intervention. Now beginning the third year of a 5-year grant from NIH-NIDDK, we have completed recruitment of 192 African Americans with NIDDM who reside in East Baltimore and receive primary health care from sites affiliated with Johns Hopkins and its Internal Medicine training program. Each participant has been assigned to one of four parallel arms: 1) usual care only, 2) usual care + community outreach, 3) usual care + nurse manager, and 4) usual care + community outreach + nurse-manager. Over the next 36 months, we will continue these interventions and ultimately compare their effectiveness in improving blood glucose, blood pressure, and serum lipid levels. The support of the Johns Hopkins OPD-GCRC continues to be absolutely crucial to the success of this project. It provides space and staff for all screening and data collection visits and supports laboratory analyses, data entry, and data processing.