Village doctor-led integrated care for older adults with diabetes in rural China: a cluster-randomized pilot trial

In rural China, diabetes management is still far from optimal owing to limited resources, low compliance with blood glucose monitoring, and restricted access to medical guidance.

To evaluate the effectiveness of a village doctor-led intervention that combines financial incentives and telemedicine support to improve diabetes management among older adults with type 2 diabetes in rural China.

A cluster randomized pilot study was conducted in all six village clinics of Baima Township, which were randomly assigned in a 1:1 ratio to either the usual care group or the integrated care group (combining financial incentives and telemedicine support). The primary outcome was the change in HbA1c levels from baseline to 3 months.

A total of 215 patients completed the study and were included in the final analysis (108 in the usual care group and 107 in the integrated care group). Over the 3-month intervention, the integrated care group had a greater reduction in HbA1c than the usual care group (- 0.42 ± 1.04% vs. -0.23 ± 1.12%), although the difference was not statistically significant. A significant decreasing trend in fasting glucose was observed across the 13-week period (β = -0.077, 95% CI - 0.109 to - 0.046; P < 0.001), with greater reductions in the integrated care group (β = -0.047, 95% CI - 0.087 to - 0.007; P = 0.023). Postprandial glucose levels also showed a modest downward trend, although the between-group difference was not statistically significant. The mean monthly adherence to blood glucose monitoring was significantly higher in the integrated care group than in the usual care group (87.60% vs. 76.47%; mean difference 11.17%, 95% CI 5.10% to 17.23%; P < 0.001).

This pilot trial showed that a village doctor-led intervention combining small non-cash incentives with telemedicine support improved adherence to blood glucose monitoring among older adults with type 2 diabetes in rural China. Although no significant change in HbA1c was observed over 3 months, favorable trends in other outcomes suggest potential benefits. These findings suggest that such a model may represent a potentially feasible approach for improving diabetes management in rural primary care settings, which warrants confirmation in larger studies.

This study was registered at the Chinese Clinical Trial Registry (Registration number: ChiCTR2400088221, registered on 2024-08-13, https://www.medicalresearch.org.cn/login ).