The global prevalence of type 2 diabetes mellitus (T2DM) continues to rise, posing a significant public health challenge. The shared care model for diabetes has shown substantial clinical value in managing T2DM. However, most research focuses on the short-term effects, while long-term outcomes remain underexplored. Additionally, there is a lack of longitudinal studies examining the relationship between follow-up frequency, app activity levels, and metabolic indicators in T2DM patients.

To assess the impact of regular outpatient follow-up and off-site app activity on the metabolic indicators of T2DM patients within the shared care model, and to identify factors influencing regular follow-up, providing a reference for promoting regular follow-up in T2DM management.

A total of 448 T2DM patients managed in the shared care outpatient clinic of a tertiary hospital in Gansu Province from 2021 to 2023 were included. Based on clinical records, patients were divided into two groups: the regular follow-up group (≥1 visit every 3 months) and the non-regular follow-up group. Health records from the previous 3 years were reviewed, and metabolic indicators (BMI, waist circumference, hip circumference, HbA_1c levels) , complication screening data, and off-site app activity levels were collected. The differences in metabolic indicators between the two follow-up groups and the varying app activity levels were compared, and Logistic regression was performed to identify factors influencing regular follow-up.

Among the 448 patients, 90 (20.1%) were in the regular follow-up group, and 358 (79.9%) were in the non-regular follow-up group. The regular follow-up group exhibited significantly higher app activity levels than the non-regular follow-up group (P<0.05) . Significant time, group, and interaction effects on HbA_1c levels were observed in the regular follow-up group (P<0.05) . After 3 years, the regular follow-up group had higher HbA_1c target achievement rates, and more frequent active screening (P<0.05) . Among patients with high APP activity levels (measured by online communication time, blood glucose monitoring frequency, meal tracking frequency, and app login duration) , significant time and group effects on HbA_1c levels were also observed (P<0.05) , but the interaction between APP activity and time was not significant (P>0.05) . Multivariate Logistic regression analysis revealed that patients with a monthly household income ≥2 000 yuan, those undergoing medication therapy, and those with higher baseline HbA_1c levels were more likely to engage in regular follow-up (P<0.05) .

In the shared care model, regular outpatient follow-up is an effective strategy for controlling blood glucose in T2DM patients. Patients should be encouraged to engage in regular follow-up visits. Furthermore, active participation in the app is closely associated with improved blood glucose control. Promoting online engagement, especially for patients with limited access to healthcare, provides an economically feasible and effective approach to diabetes management.