MeifangChen1*,DanielWeissglass2,ChengyiLi3,DiLi3,ZixuanWu3andLiZhang4
Abstract
BackgroundWhiletheuseofself-managementappshasconsiderablepromisetoefficientlyreducethediabetesburdenthatdisproportionallyaffectslow-andmiddle-incomecountries(LMICs),andthemultisectoralandmultidisciplinaryapproacheshavebeenencouragedtobeusedindiabetesmanagement,littleisknownaboutthestatusoftheintegrationoftheseapproachesintheexistingdiabetesself-managementapps.ThisreviewexaminesthediabetesappsinChinaasanindicationofthecurrentstatusofintegratingmultisectoralandmultidisciplinaryapproachesindiabetesmHealthcareinLMICs.
MethodsEligiblediabetesappsweresearchedonmajorChineseappstoresuptoDecember23,2022.Theappcomprehensivenessindex(ranging0–80)regardingtheappfunctionsanddiabetesmanagementdomainswascreated.Themultisectoralandmultidisciplinaryfeaturesweresummarizedusingindicesderivedfromcurrentguidance.
ResultsSixty-sixappswerereviewed,alldevelopedbyprivatecompanies.Theaveragecomprehensivenessscorewas16,withmanymajorself-managementdomainsandfunctionsnotrepresentedamongthereviewedapps.Fortyapps(61%)involvedmultiplesectoralentities,withpublic/privateandprivate/privatecollaborationsbeingthemostcommoncollaborativecombinations.Thirty-sevenapps(56%)involvedmultipledisciplines,amongwhichendocrinology/metabolism,nutrition,andcardiovascularmedicinewerethetopthreemostcommondisciplines.Comparedtonon-multidisciplinaryapps,multidisciplinaryappstendedtoprovidemorecomprehensiveservicesinapps(6.14vs.5.18,p=0.0345).Differentsectorsanddisciplinestendedtoworkindependently,withoutrobustinteractions,inprovidingdiabetesmanagementservicesinthereviewedapps.
ConclusionMultisectoralandmultidisciplinaryfeatureshaspresentedinthecurrentdiabetesself-managementappsinChina;however,itisstillinitsinfancyandsignificantlimitationsexisted.Moreengagementofcivilsocietyorganizationsandcommunitygroupsandinnovativecollaborationsbetweensectorsanddisciplinesareneededtoprovidecomprehensive,continuous,andpatient-centeredmHealthcareforpatientswithdiabetesinLMICslikeChina.Clearguidanceforintegratingandevaluatingthemultisectoralandmultidisciplinaryeffortsinself-managementapps
isnecessarytoensuretheeffectiveuseofmHealthsolutionsfordiabetesmanagementinLMICs.
KeywordsDiabetes,Self-management,Multisector,Multidisciplinarity,LMICs,China,mHealth
*Correspondence:
MeifangChen
该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。
Fulllistofauthorinformationisavailableattheendofthearticle
Background
Diabetesdisproportionallyaffectslow-andmiddleincomecountries(LMICs),with80%ofadultsdiagnoseswithdiabetesin2021–andanestimatedadditional210millionundiagnosedadults–livinginLMICs[1].Itsimpactissignificant,with31.2per100,000peopledyingofdiabetes-relatedcauses,andaDALYburdenof1108.3per100,000personsperyearinLMICsin2019,eachabouttwicethecorrespondingrateinHICs[2].TismakesdiabetesmanagementacriticalconcernforLMICs.
Duetothecomplexinteractionofdiabetesanditseffectswithfactorsspanningawiderangeofsocialsystems(e.g.,foodsystems,education,healthcare,etc.),theWHOGlobalActionPlanforPreventionandControlNCDs2013–2030emphasizestheimportanceofapplyingthemultisectoralapproachtoaddressingnoncommunicablediseases(NCDs)likediabetes[3].Multisectoralapproachesrecruitpublicsectors,privatesectorsandcivilsocietyorganizationstoprovidethenecessarysupporttopreventandtreatdiabetes[4].Moreover,theGlobalPartnershipforEffectiveDiabetesManagementhasrecommendedtheimplementationofaninterdisciplinaryteam(IDT)approach,whichintegratesexpertisefrommultiplemedicaldisciplines,tohelppeoplemanageandcontroltheirdiabetesconditions[5].
Integratingmultisectoralandmultidisciplinaryapproachescanbedemanding,especiallygiventheresourceandhealthsystemlimitationsofLMICs.Mobiletechnologies,whichhavebeendemonstratedtoprovideeffectiveandefficientmeansforovercominghealthsystemlimitationsinLMICs,provideapromisingplaceforsuchintegrationtooccur[6,7].DiabetesmanagementmHealthefforts,chieflyintheformofself-managementapps,areabletoimprovecommunicationwithhealthproviders,buildpeersupportivesocialnetwork,increasemedicationadherence,facilitatehealthylifestylemodification,andyieldasignificantreductioninhemoglobinA1Candcomplications[4,8–10].
AnaturalhopeisthatthemultisectoralandmultidisciplinarycollaborationnecessaryforeffectivediabetesmanagementinLMICsmightbeefficientlyaccomplishedthroughmobilesystems.However,whilestudieshavereviewedcurrentdiabetesself-managementappsandtheirimpactondiabetes-relatedoutcomesamongpatients,littleisknownabouttheintegrationofmultidisciplinaryandmultisectoralapproacheswithinthoseappsavailableinLMICs.Thisstudyaimstobeginexploringtheseissuesbyreviewingdiabetesself-managementappsinChina,whichservesasaparticularlyinformativecaseforseveralreasons:
1)Chinahas–andlikelywillcontinuetohave—theworld’slargestdiabetesepidemic,andtheincidenceofdiabeteshasincreasedmorerapidlyinChinathanintheworldasawhole[11–15].Tissuggeststhatthedemandforeffectiveappsshouldbecomparativelyhigh.
2)ChinafaceshealthworkforcechallengessimilartothosefacedbyotherLMICs,whichmakesdevelopingeffectivesystemsofself-managementfordiabetesmanagementessential[16,17].
3)MobilepenetrationinChinaishigh,andChineseappmarketplacesarewell-developed,suggestingthattherearefewsupply-sidebarriersforthedevelopmentofdiabetesmanagementappsandprovidingagood‘best-case’perspectiveformobilesystemandappdevelopmentinotherLMICs[18].
Thisstudyreviewsthemultisectoralandmultidisciplinaryintegrationindiabetesself-managementappsavailableintheChinesemarket.Thefindingsfromthisstudywill1)extendourcurrentknowledgeaboutthedevelopmentstageofintegratingmultisectoralandmultidisciplinaryapproachesindiabetesmanagementmHealthapplicationsinChina,and2)highlightthegapbetweenthediabetesself-managementguidanceandthemHealthapplicationpractices,andprovideusefulinformationforfutureappimprovement,intermsofengagingdifferentsectorsanddisciplinesandfacilitatingeffectivemultisectoralandmultidisciplinarycollaborations.
Methods
Searchstrategiesandselectioncriteria
Diabetesself-managementappswereidentifiedbysearchingtermsrelatingtodiabetes(e.g.,“diabetes/糖尿病,”“glucose/血糖,”“insulin/胰岛素,“diet/饮食,”“exercise/锻炼,”etc.)intheappstoresofthefourmajorsmartphonebrandsinChina–Xiaomi,Vivo,Apple,andHonor,representing67%oftheChinesesmartphonemarketasofDecember23,2022[19].Appsweredeemedeligibleforinclusionaccordingtothefollowingcriteria:1)theyweredesignedfordiabetesmanagement,and2)theirinterfacewasChinese.Appswereexcludedif:1)werenotdesignedfordiabetesmanagementorexclusivelyforlifestylemanagement(e.g.,generalwellbeing,dietmanagement);2)werenotdesignedforpatientuse;3)hadnotbeenupdatedinthepastfiveyears;or4)couldnotbedownloaded.
Appreviewanddataextraction
First,appname,developer,purpose,numberofdownloads,userrating,releasedate,dateofmostrecentupdate,cost,andguidance/evidencebasiswasextractedfromthedescriptionpageandtheactualappcontent.Second,theusabilityoftheappswereassessedusingtheframeworksadoptedfromArnholdetal.study(Additionalfile1:AppendixA)[20].
Finally,themultisectoralandmultidisciplinaryfeaturesofthereviewedappswereassessed.Sectorsweredividedinto‘public’,‘private’,and‘civilsocietyorganizations’,aspertheWHOToolkitforDevelopingaMultisectoralActionforNoncommunicableDiseases[4].Theroleofeachsectorwasassessedforeachdiabetesmanagementfunctionanddomain.Multidisciplinaritywasassessedbyreviewingin-appeducationandconsultationsectionsforthenameofdifferentdisciplines,usingtheChinese‘ListofMedicalInstitutions’DiagnosisandTreatmentSubjects’tostandardizethedisciplinenames[22].Thenumberandnameofdisciplinesandtheircollaborationsintheappsweresummarizedandreported.
Datasynthesisandanalysis
Contentanddescriptiveanalyseswereusedtoreportontheapps’specificcharacteristics.Chi-squareandANOVAtest,whicheverwasappropriate,wereusedtocomparetheappsinsubgroups.ExcelforMicrosoft365wasusedforanalysis.
Results
Basiccharacteristics
Multisectoralcollaborationendeavor
Fortyreviewedapps(61%)involvedmorethanonesectorintheirdevelopmentand/ordiabetesself-managementserviceprovision(Table3).Amongthemultisectoralapps,14appsinvolvedtwosectoralentities,eightappsinvolvedthreeentities,eightinvolvedfourentities,eightinvolvedfiveentities,andtwoinvolvedsixentities.Public/private(n=28)andprivate/private(n=26)collaborationswerethemostcommoncollaborativecombinations,andeighteenreviewedappsincludedbothpublic/privateandprivate/privatesectorcooperations.Hospitalswerethemostcommonpublicsectorentity,whichappearedin27multisectoralapps,followedbycommunityhealthcenters(n=3).Health/medicaltechnologycompanieswerethemostcommonprivatesectorentities,appearedin34multisectoralapps,followedbyhealthcaremanagementcompanies(n=24),andnutritionandfoodcompanies(n=17),pharmaceuticalcompanies(n=10),andinformationtechnologycompanies(n=8).Terewasonlyonecivilsocietysectorentity(HealthTimes(健康时报),amediaagency,intheRenminHealthapp)involvedinthereviewedapps.
Differentsectorstendedtoprovidedifferentdiabetesservicefunctionsviathereviewedapps.Publicsectorslikehospitalsweremainlyinvolvedinadvisingandeducationfunctionsinthereviewedapps.Theengagementofprivatesectorsseemedtopredicttheinclusionofinterface,dataanalysis,datasharing,andshoppingfunctionsofthereviewedapps.Theparticipationofmedicaldevicecompanies,inparticular,tendedtoresultinaninterfacefunction,whiletheinvolvementofpharmaceuticalcompanies,foodproducers,andinsurancecompaniesweremorelikelytoincludeshoppingfunctions.Civilsocietyorganizationinvolvementcontributedtospreadinghealtheducationinformationandempoweringtheappusers.
Evenwhiletherewassignificantmultisectorpresenceinthereviewedapps,differentorganizationstendedtotakechargeofspecificpartsoftheapp,butrarelycollaboratewitheachotherinanintegrated,multisectoralapproachtoanyparticularfunction.Forinstance,severalappscontractedwithhealthprofessionalsfromdifferenthospitalsandmedicalcompaniesandallowedthehealthprofessionalstoprovideconsultingandadvisingservicestotheappusers;however,therewaslackofobviouscommunicationandcollaborationbetweenhospitals(publicsector)andmedicalcompanies(privatesector)intermsofprovidingholistic,comprehensivediabetesmanagementcareservicestotheappusers.Similarpatternshavebeenobservedamongthesametypeofsectoragencies.Forinstance,CaringChurch(关心堂)apppartneredwithhospitalsandlocalcommunityhealthcenters,bothofwhichwerepublicsectorentities.Althoughboththeagenciesprovidedvariousservicesviatheapp,therewasnodirectcollaborationbetweenthehospitalsandthecommunityhealthcenters(likereferringpatientsandprovidingcontinuouscaretotheusers).
Multidisciplinarycollaborationendeavor
Thirty-sevenofthereviewedapps(56%)involvemorethanonediscipline.Fourapps–People’sHealth,ZhiyunHealth,CaringChurch,andMasterFang–includedover20disciplinesintheirapps.Themostcommondisciplineswereendocrinology(n=34)andnutrition(n=34),followedbycardiovascularmedicine(n=28),ophthalmology(n=22),gastroenterology(n=18),generalsurgery(n=18),stomatology(n=18),nephrology(n=17),psychiatry(n=11),rheumatology(n=11),dermatology(n=10),orthopedics(n=10),respiratorymedicine(n=10),obstetricsandgynecology(n=10),traditionalChinesemedicine(n=9),otorhinolaryngology(n=8),oncology(n=6),neurology(n=5),urology(n=5),infectiousdiseases(n=7),pediatrics(n=5),andrology(n=4),anorectal(n=4),neurosurgery(n=3),internalmedicine(n=3),thoracicsurgery(n=3),emergencymedicine(n=2),hematology(n=2),plasticsurgery(n=2),rehabilitation(n=2),sexuallytransmitteddiseases(n=2),burns(n=1),tuberculosis(n=1),andcriticalcaremedicine(n=1),amongwhichsomedisciplinesthatseemednotdirectlyrelatedtodiabeteswerealsopresented.
Multidisciplinaritywasmostoftenreflectedintheeducationandadvisingfunctionsoftheapps.Regardingtheeducationfunction,36multidisciplinaryapps(97%)providedvariousarticlesandvideosgeneratedbydifferentdisciplinaryprofessionalstointroducediabetesanditsriskfactorandcomplicationmanagementknowledgeandskills.Fifteenofthemultidisciplinaryapps(41%)providedadvisory/therapysupportthatincludedprofessionalsfrommultipledisciplinarybackgrounds,amongwhich13apps(87%)requiredpaymentformultidisciplinaryconsultingservices.Multidisciplinaryappstendedtohaveahighercomprehensivenessscorethanothers(6.14vs.5.18,p=0.0345).
Evenformultidisciplinaryapps,onlyafewapps(n=4;11%)involvedmultipledisciplinesintheprovisionofanyspecificservice,withmostinterdisciplinaryappshavingdifferentdisciplinesworkseparately–resultinginafailuretointegrateinterdisciplinaryperspectives.Inprovidingeducationalinformationtoempowertheappusers,manyofthematerialsweregeneratedbyprofessionalsfromasingledisciplineoronlycontainedinformationrelevanttoasinglediscipline.Regardinghealthdatamonitoringandanalysis,althoughmanyappsallowedmultidisciplinarydataenteringandsharing,theanalysisandpresentationoftheanalysisresultswereindependentandnotintegrated.Similarly,whensomeappscontractedwithprofessionalsfromdifferentdisciplinestoprovideconsultationservicestotheappusers,theprofessionalswereusuallyworkingindependentlyandprovidingrecommendationswithoutconsultingprofessionalsfromotherdisciplines.
Discussion
Thisstudyreviewsdiabetesself-managementappsinChina,withaparticularfocusondescribingthemultisectoralandmultidisciplinaryeffortsthathadbeenmadeinmHealthcaretoprovideeffective,comprehensive,continuouscaretopatientswithdiabetes.Mostofthe66reviewedappsweresolelydesignedfordiabetesselfmanagement,butonly3appsweredevelopedforspecifictypesofdiabetesmanagement.Differenttypesofdiabetesrequiredifferentpreventionandtreatmentmeasurestofulfillthepatients’needsandimprovetheprognosis.Thelackofspecificationofthediabetestypesmayleadtocompromiseinservicequality,whichisasignificantshortagereflectedamongthereviewedapps.
Thecomprehensivenessofthereviewedappsisrelativelylow.Manykeydiabetesmanagementfunctions(e.g.,advising,reminding,interfacing,datasharingandanalysis)anddomains(e.g.,lifestylemodification,medication,andcomplicationmanagement)arepoorlyaddressedinexistingappsolutions.Futureappsneedtoprovidemorecomprehensiveservices,particularlycoveringlifestylerisks(especiallysmoking,alcoholuse,psychosocialstatus,andsaltintake),medicationandcomplicationmanagementdomains.
About61%oftherevieweddiabetesself-managementappsweremultisectoral,butthenatureofthiscollaborationwaslimitedbyanoverrepresentationofprivatesectorpartners,theunderrepresentationofcommunity-basedpublicsector,afailuretoengagecivilsocietyorganizations(CSOs),andalackofintegrationincollaboration.Allreviewedappsweredevelopedatleastinpartbyprivatesectorentities,themajorityofwhichweremedicaldevicecompanies.Whiletheprivatesectorisacriticalpartofmultisectoralcollaboration,theiroverrepresentationrisksanexcessivelyprofit-drivenapproachtodiabetesmanagement.Forinstance,appsdevelopedbymedicaldevicecompaniesusuallyrestricttheirappstointerfacewiththeirowndevicesandhavebuilt-in-appmarketthatonlyselldevicesfromtheirowncompanies.Moreover,asobserved,manycompaniesfailedtoprioritizecomprehensive,high-qualitydiabetesmanagementbyinadequatelyreferringtoscientificevidenceand/orappropriateguidelinesfordiabetesmanagementintheirappandcontentdevelopmentprocess.
Conversely,communitystakeholderswereonlyincludedbythreeapps—“CaringChurch(关心堂)”,“HuiHealth(慧健康)”,and“SharedCare(共同照护)”,whichincludedcommunityhealthcentersaspartnersinappdevelopmentorserviceprovision.Primaryhealthcare,asthefirstcontactwithtargetpopulation,providesthefoundationsofhealthequityandguaranteehealthservicedelivery.Theinvolvementandcollaborationofcommunity-basedhealthcareentitieswithothersectorentitiesviamobilehealthtechnologiesisnecessaryandimportantinstrengtheningdiabetesself-management.Futureappsneedtoengagemorecommunity-levelhealthsectorsandprovidethemwithaconvenientplatformforeffectivelycollaboratingwithothersectors,inordertoprovidecontinuous,high-qualitydiabetesservicestoappusers.
Likewise,thereviewedappsfailedtoengagecivilsocietyorganizations(CSOs)intheapps.IncreasingevidencehasshownthatCSOscouldplayimportantrolesinNCDspreventionandcontrol[23,24].Inthisreview,onlyoneappengagedaCSO,whilealmostalltheidentifiedsectorsintheappswerepublicorprivatesectorentities.MoreCSOs(e.g.,academicinstitutions,nonprofits,voluntaryorganizations,etc.)shouldbeengagedindiabetesself-managementappstosupportevidencebaseddevelopment,trainingandprovidingpersonnel,andotherfunctions.Finally,thecontributionsofdifferentsectorstendtobepoorlyintegratedinthereviewedapps.Partnersfromdifferentsectorstendedtoeachcontributetospecificappfunctions,whiletheydidnotmeaningfullyinteractwitheachothertooptimizethediabetesmanagementfunctionsandservicesintheapps.Thisreflectsongoingintersectoralfragmentationrepresentedinthehealthcaresystem.Robustcollaborationmechanismsareneededtotacklethisissueonthemobileplatform.
Conclusions
Abbreviations
LMICsLow-andmiddle-incomecountries
DALYsDisability-adjustedlifeyears
WHOWorldHealthOrganization
IDTInterdisciplinaryteam
HbA1cHemoglobinA1C
CSOsCivilsocietyorganizations
NCDsNon-communicablediseases
SupplementaryInformation
Additionalfile1:AppendixA.UsabilityScoresoftheReviewedDiabetesSelf-ManagementApps(N=66).
AppendixB.ComprehensivenessoftheReviewedDiabetesSelf-ManagedApps(N=66).
Acknowledgements
ThankstotheDKUGlobalHealthResearchCenterforsupporttheproject.
Authors’contributions
MCconceptualizedanddesignedthestudy,acquiredfunding,conductedtheinvestigation,analyzedandvalidatedthedata,draftedandeditedthemanuscript,andsupervisedtheproject;DEWinterpretedtheresults,anddraftedandeditedthemanuscript.CL,DL,andZWconducteddatacurationandanalysis,anddraftedthemanuscript.LZeditedthemanuscriptandacquiredfundingfortheproject.Allauthorsreviewedthemanuscript.
FundingTheresearchresultsofthisarticle(orpublication)aresponsoredbytheKunshanMunicipalGovernmentresearchfunding.Thefunderplayednootherroleintheproductionofthisresearch.
Availabilityofdataandmaterials
Alldatageneratedoranalyzedduringthisstudyareincludedinthispublishedarticle[anditssupplementaryinformationfles].
Declarations
Ethicsapprovalandconsenttoparticipate
Notapplicable.
Consentforpublication
Competinginterests
Theauthorsdeclarenocompetinginterests.
Authordetails
1DivisionofSocialScience,GlobalHealthResearchCenter,DukeKunshanUniversity,8DukeAvenue,Suzhou215316,Jiangsu,China.
2DivisionofArtsandHumanities,DukeKunshanUniversity,8DukeAvenue,Suzhou,Jiangsu,China.3DukeKunshanUniversity,8DukeAvenue,Suzhou,Jiangsu,China.
4DepartmentofEndocrinology,TheFirstPeople’sHospitalofKunshan,188JijieSt.,Suzhou,Jiangsu,China.
Received:23June2023Accepted:11September2023
Publishedonline:25September2023
References
2.LiuJ,BaiR,ChaiZ,CooperME,ZimmetPZ,ZhangL.Low-andmiddleincomecountriesdemonstraterapidgrowthoftype2diabetes:ananalysisbasedonGlobalBurdenofDisease1990–2019data.Diabetologia.2022;65(8):1339–52.
3.OrganizationWH.Globalactionplanforthepreventionandcon-trolofNCDs2013–2020.2014.
4.WorldHealthOrganization.Toolkitfordevelopingamultisectoralactionplanfornoncommunicablediseases:overview.Geneva:WorldHealthOrganization;2022.
5.BaileyCJ,AschnerP,DelPratoS,LaSalleJ,JiL,MatthaeiS,ManagementGPfED.Individualizedglycaemictargetsandpharmacotherapyintype2diabetes.DiabVascDisRes.2013;10(5):397–409.
6.El-KhatibZ,ShahM,ZallappaSN,NabethP,GuerraJ,ManenguCT,YaoM,PhilibertA,MassinaL,StaigerCP,etal.SMS-basedsmartphoneapplicationfordiseasesurveillancehasdoubledcompletenessandtimelinessinalimited-resourcesetting-evaluationofa15-weekpilotprograminCentralAfricanRepublic(CAR)11medicalandhealthsciences1117publichealthand.ConfHealth.2018;12:1–11.
7.AgarwalS,PerryHB,LongLA,LabriqueAB.EvidenceonfeasibilityandeffectiveuseofmHealthstrategiesbyfrontlinehealthworkersindevelopingcountries:systematicreview.TropMedIntHealth.2015;20(8):1003–14.
8.YangY,LeeEY,KimH-S,LeeSH,YoonKH,ChoJH.Effectofamobilephone-basedglucose-monitoringandfeedbacksystemfortype2diabetesmanagementinmultipleprimarycareclinicsettings:clusterrandomizedcontrolledtrial.JMIRMhealthUhealth.2020;8(2):e16266.
9.KebedeMM,PischkeCR.Populardiabetesappsandtheimpactofdiabetesappuseonself-carebehaviour:asurveyamongthedigitalcommunityofpersonswithdiabetesonsocialmedia.FrontEndocrinol(Lausanne).2019;10:135.
10.Brew-SamN,ChibA,RossmannC.Diferentialinfuencesofsocialsupportonappusefordiabetesself-management-amixedmethodsapproach.BMCMedInformDecisMak.2020;20(1):151–151.
11.WangL,PengW,ZhaoZ,ZhangM,ShiZ,SongZ,ZhangX,LiC,HuangZ,SunX.PrevalenceandtreatmentofdiabetesinChina,2013–2018.JAMA.2021;326(24):2498–506.
12.ZhouB,LuY,HajifathalianK,BenthamJ,DiCesareM,DanaeiG,BixbyH,CowanMJ,AliMK,TaddeiC.Worldwidetrendsindiabetessince1980:apooledanalysisof751population-basedstudieswith4·4millionparticipants.Lancet.2016;387(10027):1513–30.
13.GroupNDR.Amasssurveyofdiabetesmellitusinapopulationof300,000in14provincesandmunicipalitiesinChina.ZhonghuaNeiKeZaZhi.1981;20(11):678–83.
14.ChoNH,ShawJE,KarurangaS,HuangY,daRochaFernandesJD,OhlroggeAW,MalandaB.IDFDiabetesAtlas:globalestimatesofdiabetesprevalencefor2017andprojectionsfor2045.DiabetesResClinPract.2018;138:271–81.
15.SunH,SaeediP,KarurangaS,PinkepankM,OgurtsovaK,DuncanBB,SteinC,BasitA,ChanJC,MbanyaJC.IDFDiabetesAtlas:Global,regionalandcountry-leveldiabetesprevalenceestimatesfor2021andprojectionsfor2045.DiabetesResClinPract.2022;183:109119.
16.YaoM,ZhangDY,FanJT,LinK,HaroonS,JacksonD,LiH,ChenW,LehmanR,ChengKK.TheexperiencesofChinesegeneralpractitionersincommunicatingwithpeoplewithtype2diabetes—afocusgroupstudy.BMCFamPract.2021;22(1):156.
17.SunM,RasoolyA,FanX,JianW.AssessingthequalityofprimaryhealthcarefordiabetesinChina:multivariateanalysisusingtheChinaHealthandRetirementLongitudinalStudy(CHARLS)Database.BMJOpen.2020;10(12):e035192.
18.HuangJ.Insightsinto:Asia’stopmobilemarkets(China,Korea,Japan).Amsterdam:NewzooInternationalB.V.;2019.
20.ArnholdM,QuadeM,KirchW.MobileApplicationsfordiabetics:asystematicreviewandexpert-basedusabilityevaluationconsideringthespecialrequirementsofdiabetespatientsage50yearsorolder.JMedInternetRes.2014;16(4):e104.
21.中华医学会糖尿病学分会国:国家基层糖尿病防治管理指南(2022).中华内科杂志2022;61(3):249–262.
23.AllenN,CherlinE,WongR,MantopoulosJ,delaPezaL.Evaluatingleadership,management,andgovernancecapacitybuildinginRwandainroleofuniversitiesinstrengtheninghealthsystemsinlow-incomesettings.AnnGlobHealth.235.
24.OrganizationWH.ReportoftheSouth-EastAsiaRegionalMeetingonStrengtheningNCDCivilSocietyOrganizations.Amsterdam:WHORegionalOfficeforSouth-EastAsia;2015.
26.JoretMO,OsmanK,DeanA,CaoC,vanderWerfB,BhamidipatyV.Multidisciplinaryclinicsreducetreatmentcostsandimprovepatientoutcomesindiabeticfootdisease.JVascSurg.2019;70(3):806–14.
27.JiaoF,FungCSC,WanYF,McGheeSM,WongCKH,DaiD,KwokR,LamCLK.Long-termeffectsofthemultidisciplinaryriskassessmentandmanagementprogramforpatientswithdiabetesmellitus(RAMP-DM):apopulation-basedcohortstudy.CardiovascDiabetol.2015;14:1–11.
28.FosterD,Sanchez-CollinsS,CheskinLJ.Multidisciplinaryteam–basedobesitytreatmentinpatientswithdiabetes:currentpracticesandthestateofthescience.DiabetesSpectrum.2017;30(4):244–9.
29.McGillM,BlondeL,ChanJC,KhuntiK,LavalleFJ,BaileyCJ.Theinterdisciplinaryteamintype2diabetesmanagement:challengesandbestpracticesolutionsfromreal-worldscenarios.JClinTranslEndocrinol.2017;7:21–7.
Publisher’sNote
SpringerNatureremainsneutralwithregardtojurisdictionalclaimsinpublishedmapsandinstitutionalaffiliations.
ThisarticleisexcerptedfromtheBMCPublicHealthbyWoundWorld.
网友、医生言论仅代表其个人观点，不代表本站同意其说法，请谨慎参阅，本站不承担由此引起的法律责任。