With the rising prevalence of diabetes and the widespread adoption of intensive glucose-lowering therapies, the incidence of hypoglycemia has increased significantly. The hazards and management of hypoglycemia remain critical clinical challenges.

To investigate the effect of the "General-Specialty" graded precision management model on the physical and mental health of type 2 diabetes patients with hypoglycemia in the community.

A total of 120 T2DM patients with a history of hypoglycemia within 6 months, who attended Shanggang Community Health Service Center in Pudong New Area, Shanghai from January to July 2023, were enrolled. The patients were divided into a control group and an experimental group, with 60 cases in each group, using a random number table method. The control group received routine management, while the experimental group was subjected to the "General-Specialty" graded precision management model. Based on the severity of hypoglycemia and individual patient conditions, subjects in the experimental group were referred to general practice clinics, specialized diabetes clinics, or transferred to tertiary hospitals. Additionally, comprehensive interventions were implemented, including real-time data-driven precise management, psychological intervention, comprehensive health education, and the establishment of a family support system. After 6 months of intervention, the two groups were compared in terms of blood glucose control parameters [fasting plasma glucose (FPG), hemoglobin A_1c(HbA_1c), time in range (TIR), and blood glucose coefficient of variation (CV)], the number of hypoglycemic episodes (total, mild, moderate, and severe), scores on the Chinese Hypoglycemia Fear Survey-Worry Scale (CHFSⅡ-WS), and the total score and dimension scores of the Diabetes-Specific Quality of Life Scale (DSQL). To evaluate the impact of the "General-Specialty" graded precision management model on the blood glucose control and fear of type 2 diabetes patients with hypoglycemia, and then evaluate the significance of this management model on the management of type 2 diabetes patients with hypoglycemia in the community.

During the intervention period, 1 patient in the experimental group was lost to follow-up due to residential relocation. The results of repeated measures ANOVA showed that there was no interaction between group and time on BMI and waist circumference (F_interaction =1.922, 1.134; P_interaction =0.162, 0.320).Time exerted a significant main effect on BMI and waist circumference (F_time=7.507, 4.097; P_time=0.003, 0.021), whereas group had no significant main effect on these parameters (F_group=0.598, 0.138; P_group=0.441, 0.711). No interaction between group and time was observed for systolic blood pressure (SBP) or diastolic blood pressure (DBP) (F_interaction =0.868, 0.151; P_interaction =0.419, 0.860), and neither time nor group had a significant main effect on SBP or DBP (F_time=1.295, 1.267; P_time=0.276, 0.284; F_group=1.750, 0.337; P_group=0.188, 0.562). Significant interactions between group and time were detected for FPG, HbA_1c, and CV (F_interaction =36.662, 15.157, 10.767, P_interaction <0.001). Both time and group had significant main effects on FPG, HbA_1c, and CV (F_time=105.098, 60.155, 41.307; P_time<0.001; F_group=6.916, 4.357, 4.094; P_group=0.010, 0.039, 0.045). A significant interaction between group and time was also found for TIR (F_interaction =4.767, P_interaction =0.012). Time had a significant main effect on TIR (F_time=13.456, P_time<0.001), but group did not (F_group=3.405, P_group=0.068). After 6 months of intervention, the total number of hypoglycemic episodes, as well as the number of mild and moderate episodes, was significantly lower in the experimental group than in the control group (all P<0.05). Post-intervention scores of CHFSⅡ-WS, total DSQL, and all DSQL dimension scores were significantly lower in the experimental group than in the control group (all P<0.05). Furthermore, these scores were significantly lower in the experimental group post-intervention compared with pre-intervention (all P<0.05).

The "General-Specialty" graded precision management model improves glycemic control, reduces glucose variability, and lowers hypoglycemia risk, thereby enhancing community-based T2DM hypoglycemia management. It alleviates fear of hypoglycemia, improves self-management, and enhances quality of life.

随着糖尿病发病率不断升高，强化降糖治疗策略广泛普及，低血糖的发生率随之增加，低血糖的危害及防治是临床亟待解决的重大问题。

探究"全-专"分级精准管理模式对社区2型糖尿病低血糖患者身心健康的影响。

选取2023年1—7月于上海市浦东新区上钢社区卫生服务中心就诊的半年内有低血糖发作史的2型糖尿病患者为研究对象，采用随机数字表法将患者分为对照组和试验组，每组60例。对照组进行常规管理；试验组纳入"全-专"分级精准管理模式，依据患者低血糖严重程度和实际情况，分至全科门诊、专病门诊或转至上级医院就诊，并给予实时数据驱动的精准管理、心理干预、全面宣教及引入家庭支持系统等综合管理。干预6个月后，比较干预后两组血糖控制指标[空腹血糖（FPG）、糖化血红蛋白（HbA_1c）、目标范围内时间（TIR）及血糖变异系数（CV）]、低血糖发生次数（总次数、轻度、中度、重度）、中文版低血糖恐惧-忧虑量表（CHFS Ⅱ-WS）评分、糖尿病患者生存质量特异性量表（DSQL）总分及各维度评分。评估"全-专"分级精准管理模式对2型糖尿病低血糖患者血糖控制和恐惧情绪的影响，进而评价该管理模式对社区2型糖尿病患者低血糖管理的意义。

干预期间，因住址更换，试验组1人失访。重复测量方差分析结果表明，组别和时间对BMI、腰围不存在交互作用（F_交互=1.922、1.134，P_交互=0.162、0.320）；时间对BMI、腰围主效应显著（F_时间=7.507、4.097，P_时间=0.003、0021）；组别对BMI、腰围主效应不显著（F_组间=0.598、0.138，P_组间=0.441、0.711）。组别和时间对收缩压和舒张压不存在交互作用（F_交互=0.868、0.151，P_交互=0.419、0.860）；时间和组别对BMI、腰围主效应不显著（F_时间=1.295、1.267，P=0.276、0.284；F_组间=1.750、0.337，P_组间=0.188、0.562）。组别和时间对FPG、HbA_1c、CV存在交互作用（F_交互=36.662、15.157、10.767，P_交互<0.001）；时间和组别分别对FPG、HbA_1c、CV主效应显著（F_时间=105.098、60.155、41.307，P_时间<0.001；F_组间=6.916、4.357、4.094，P_组间=0.010、0.039、0.045）。组别和时间对TIR存在交互作用（F_交互=4.767，P_交互=0.012）；时间对TIR主效应显著（F_时间=13.456，P_时间<0.001）；组别对TIR主效应不显著（F_组间=3.405，P_组间=0.068）。干预6个月后，试验组患者近半年低血糖发生总次数、轻度及中度低血糖发生次数均低于对照组（P<0.05）。干预6个月后试验组患者CHFS Ⅱ-WS评分、DSQL总分及各维度得分均低于对照组（P<0.05）。试验组干预6个月后CHFS Ⅱ-WS评分、DSQL总分及各维度得分均低于同组干预前（P<0.05）。

"全-专"分级精准管理模式通过系统化的管理与干预能够改善患者的血糖控制水平，减少血糖波动，降低低血糖发生风险，提升社区2型糖尿病低血糖管理水平及效率。该管理模式有助于缓解患者对低血糖的恐惧情绪，改善患者自我管理能力，提升患者生存质量。