Abstract: Background The incidence of diabetes has been increasing year by year，and the management of type 2 diabetes has been included into the basic community health services as an important disease in China. However，at present，there is still a gap in the standard management of diabetes at the grass-roots level，especially in quality and ability. Objective To understand the current situation of diabetes management in Shanghai community health institutions and conduct systematic quality evaluation，and to put forward corresponding optimization suggestions for existing problems. Methods The research was conducted in May 2022，and the target population included，（1）community health service centres：all community health service centres in 16 administrative districts of Shanghai，with a total of 249 institutions；and（2）community general practitioners：3 875 community general practitioners were selected by simple random sampling according to the proportion of 50% of the registered population. The questionnaire for medical institutions and the questionnaire for GPs were designed to investigate the implementation of diabetes management in community health centres and the implementation of standardized diagnosis and management of diabetes by community GPs. Results HbA1c test was available in all community health institutions in Shanghai，but the screening program for diabetes complications was insufficient，and only 16.9% of community health service centercould test nerve conduction velocity. The types of oral hypoglycemic agents are relatively complete，but the types of insulin are single，and only 7.6% of community health service center are equipped with the new hypoglycemic drug GLP-1receptor agonist. 57.4% of community health service center have set up diabetes clinics. Community general practitioners have a high degree of recognition for the standardized management of diabetes and have a good grasp of the guidelines for the basic management of diabetes，but they have a poor grasp of the basic knowledge of diabetestreatment drugs，and the correct rate of the application knowledge of oral hypoglycemic drugs and insulin is only 27.9% and 29.0%. When the blood sugar of newly diagnosed diabetic patients is high and the diagnosis of diabetic nephropathy is confirmed，the community general practitioners are more inclined to refer the patients directly to the superior hospital specialty. Conclusion The results of this survey showed that the infrastructure，equipment and drugs of diabetes management service in Shanghai community health service center have basically met the quality requirements；Gaps in knowledge of drug use；It is necessary to further improve the diabetes management quality and medical capacity of primary medical and health institutions by increasing the examination and testing items related to the screening of diabetes complications，increasing the types of new hypoglycemic drugs and insulin，strengthening the construction of diabetes specialized clinics，improving the diagnosis and treatment level of general practitioners，and standardizing the diagnosis and treatment behaviors of general practitioners.

Key words: Diabetes mellitus, Disease management, Community health centers, General practitioners, Diabetes mellitus, Grass-roots management quality

摘要： 背景 糖尿病的发病率在逐年提升，我国将 2 型糖尿病的管理作为重要病种纳入到社区基本卫生服务中；但目前糖尿病的基层规范管理，尤其是质量及能力，尚存在差距。目的 了解上海市社区卫生机构糖尿病管理的现状并进行系统性质量评价，针对存在问题提出相应优化建议。方法 调研时间为 2022 年 5 月，调研对象包括，（1）社区卫生服务中心：上海市 16 个行政区的全部社区卫生服务中心，共 249 家机构；（2）社区全科医生：按照注册人数 50% 的比例采用简单随机抽样的方法选取 3 875 名社区全科医生。自行设计医疗机构问卷和全科医生调查问卷，调查社区卫生服务中心实施糖尿病管理状况，以及社区全科医生实施糖尿病规范化诊疗和管理现况。结果 上海社区卫生服务中心均可开展糖化血红蛋白检查，但糖尿病并发症筛查项目开展不足，只有 16.9% 的社区卫生服务中心可以开展神经传导速度检查；口服降糖药的种类比较齐全，但胰岛素种类单一，仅有 7.6% 的社区卫生服务中心配备有新型降糖药物 GLP-1 受体激动剂；仅 57.4% 社区卫生服务中心开设了糖尿病专病门诊。社区全科医生对糖尿病规范管理认可程度高，对糖尿病基层管理指南掌握情况良好，但对于糖尿病治疗药品的基础知识掌握欠佳，对口服降糖药物应用知识正确率仅为 27.9%、对胰岛素应用知识正确率仅为 29.0%；在新发糖尿病患者血糖较高和确诊糖尿病肾病时，社区全科医生更倾向于将患者直接转诊至上级医院专科。结论 上海市社区卫生服务中心开展糖尿病管理服务的基础设施、设备、药物等条件已基本满足质量要求；在药物使用知识方面存在差距；需要通过增加糖尿病并发症筛查相关检查检验项目、增加新型降糖药物及胰岛素种类、加强糖尿病专病门诊建设，以及提高全科医生的诊疗水平，规范全科医生诊疗行为等举措，进一步提升基层医疗卫生机构糖尿病管理质量和医疗能力。

关键词: 糖尿病, 疾病管理, 社区卫生中心, 全科医生, 糖尿病基层管理质量