Bring a large pot of water to a boil. Cook macaroni noodles according to package instructions. Drain, and set aside.

Meanwhile, In a large pot, add the turkey meat and break it apart with a wooden spoon, Cook over medium-high heat for 8 to 10 minutes, until it is fully cooked and there is no more pink in the meat. Remove the meat from the pot and set aside.

In a large pot, add the olive oil over medium heat. Add in the onions and sauté for 4 minutes until they begin to brown. Add in the minced garlic, Italian seasoning, and red pepper flakes, stir, and sauté for an extra 2-3 minutes.

To the onions and garlic, add the diced tomatoes, tomato sauce, and balsamic vinegar. Add the cooked ground turkey, and stir well to combine. Simmer over medium-low heat, covered, for 15 minutes.

Add the cooked macaroni noodles back into the pot, and stir. Cook for 5 more minutes until pasta is heated through, and serve hot garnished with fresh black pepper and extra balsamic vinegar if desired.