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 A1c(HbA1c), 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 (Finteraction =1.922, 1.134; Pinteraction =0.162, 0.320).Time exerted a significant main effect on BMI and waist circumference (Ftime=7.507, 4.097; Ptime=0.003, 0.021), whereas group had no significant main effect on these parameters (Fgroup=0.598, 0.138; Pgroup=0.441, 0.711). No interaction between group and time was observed for systolic blood pressure (SBP) or diastolic blood pressure (DBP) (Finteraction =0.868, 0.151; Pinteraction =0.419, 0.860), and neither time nor group had a significant main effect on SBP or DBP (Ftime=1.295, 1.267; Ptime=0.276, 0.284; Fgroup=1.750, 0.337; Pgroup=0.188, 0.562). Significant interactions between group and time were detected for FPG, HbA1c, and CV (Finteraction =36.662, 15.157, 10.767, Pinteraction <0.001). Both time and group had significant main effects on FPG, HbA1c, and CV (Ftime=105.098, 60.155, 41.307; Ptime<0.001; Fgroup=6.916, 4.357, 4.094; Pgroup=0.010, 0.039, 0.045). A significant interaction between group and time was also found for TIR (Finteraction =4.767, Pinteraction =0.012). Time had a significant main effect on TIR (Ftime=13.456, Ptime<0.001), but group did not (Fgroup=3.405, Pgroup=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.
The report of the 20th National Congress of the Communist Party of China pointed out that it is necessary to adhere to prevention, strengthen the health management of major chronic diseases, and improve the grassroots ability to prevent and treat diseases and health management. Faced with the dual challenges of high incidence of chronic diseases and emerging infectious diseases, the traditional mode of "emphasizing treatment and neglecting prevention" has been difficult to meet the growing health needs of the people. Jiangxi Province issued Several Opinions on Accelerating the Modernization of Health and Health and Action Plan for Building a New Era of Health and Health in Jiangxi Province (2024-2027), integrating health and health modernization into the province's development strategy and formulating a series of institutional measures.
Focusing on the management of major chronic diseases, this study systematically analyzed the main trends of the current integration of medical and prevention, and explored the five major challenges faced by the current management of chronic diseases: the imbalance of supply and demand of policy tools, the lack of coordination between management departments, the lack of cooperation between departments, the uneven guarantee of talents, and the lack of self-management enthusiasm of patients.
According to the practical experience of some provinces and cities in China, the "1+2+3" model in Yichun, the "hospital management" model in Jiujiang, the "project + grid" model in Pingxiang and the "Project + grid" model in Shangrao Wuyuan were put forward.
The research has identified four representative chronic disease management models in Jiangxi Province: (1) The "1+2+3" integrated management model in Wan County, Yichun City, which uses family doctor contracting as the link to establish a closed-loop service system for prevention, diagnosis and rehabilitation; (2) The "hospital-run and hospital-managed" traditional Chinese medicine (TCM) characteristic prevention and treatment model in Jiujiang City, where public hospitals directly manage community health centers to achieve a deep integration of TCM applicable technologies and chronic disease prevention and control; (3) The close-knit medical consortium model in Pingxiang City, which relies on the three-level linkage of districts, towns and villages and information support to promote the downward flow of high-quality resources and the simultaneous management of chronic diseases; (4) The "project + grid-based" model in Wuyuan County, Shangrao City, with the H-type hypertension prevention and control project as the starting point, to build a chronic disease prevention and control network led by the government, with coordinated efforts from various departments and grid-based management. Further, four implementation paths for the integration of medical care and prevention of chronic diseases in Jiangxi Province have been condensed: coordinated governance of the system, refined integrated management, diversified TCM empowerment, and efficient linkage of medical consortia.
Jiangxi Province has initially established a replicable and scalable multi-mode approach in promoting the integration of medical care and prevention for chronic disease management. However, it still faces issues such as imbalance between policy supply and demand, poor cross-departmental collaboration, insufficient talent support, and weak patient self-management awareness. In the future, efforts should be made to improve the overall planning, strengthen policy coordination, optimize the integrated medical and prevention mechanism, leverage the advantages of traditional Chinese medicine, and provide information support. These measures aim to promote the high-quality development of the chronic disease management system and contribute to achieving the goal of modernizing health care in Jiangxi Province.
With the intensification of population aging, bone health diseases (e.g., osteoporosis, osteoarthritis, scoliosis) have become a major public health challenge in China. Traditional healthcare models, centered on acute-phase diagnosis and treatment, suffer from shortcomings such as overemphasis on treatment over prevention, fragmented services, and inadequate continuity of rehabilitation, leading to low early screening rates, poor patient compliance, and high recurrence risks. This study analyzes the core characteristics and management bottlenecks of bone health diseases. Drawing on international chronic disease management frameworks and domestic practical experience, and leveraging the resource integration advantages of family doctor contracted services, we innovatively constructed a "smart hierarchical early warning-multidisciplinary collaborative intervention-integrated medical and preventive care" model for full-cycle closed-loop management of bone health, aiming to address systemic challenges in bone health management. The innovation of this study lies in enhancing management efficiency through intelligent tools, optimizing resource allocation via multidisciplinary collaboration, and strengthening the sustainability of healthcare services through policy reforms, thereby providing a systematic paradigm for grassroots bone health management.
