The goal of this cluster randomized clinical trial is to learn if an AI-enabled blended care model (the BRIDGE program) works to treat type 2 diabetes in adults. It will also learn about the cost-effectiveness and implementation feasibility of this model in primary care settings. The main questions it aims to answer are: Does the AI-driven intervention lower HbA1c levels (blood sugar) compared to standard care? Does this model improve participants' quality of life, self-management behaviors, and digital literacy? Researchers will compare the "Diet-Medicine Companion" (Shi Yi Ban Lv) mini-program combined with family doctor support to standard community care to see if the blended care model works to manage diabetes. Participants will: Use the "Diet-Medicine Companion" mini-program to upload diet photos daily and receive AI feedback for 6 months Receive periodic guidance and phone reminders from case administrators (family doctors) Complete questionnaires and blood tests (HbA1c) at baseline, 3 months, and 6 months
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
1,200
The intervention consists of a 6-month AI-enabled blended care program using the "Diet-Medicine Companion" (Shi Yi Ban Lv) WeChat mini-program. Patient Component (AI Support): Participants are required to upload dietary photos and blood glucose records via the mini-program at least once daily. The system, powered by a Large Language Model (LLM), provides immediate, personalized dietary feedback and answers diabetes-related queries via an AI chatbot. Provider Component (Human Support): Case administrators (family doctors) monitor patient data through a provider dashboard. The protocol involves "human-in-the-loop" support, where doctors provide telephone reminders if participants are inactive (no uploads) for more than 7 days. Doctors also intervene to provide medical guidance or health education based on specific system alerts or patient needs.
Change in Glycosylated Hemoglobin (HbA1c) Levels
Glycosylated Hemoglobin (HbA1c) reflects the average plasma glucose concentration over the preceding 3 months. It serves as the gold standard biomarker for long-term glycemic control in diabetes management. Data will be obtained from venous blood samples collected at community health centers. A lower HbA1c percentage indicates better glycemic control.
Time frame: Baseline, Month 3, and Month 6
Change in Body Mass Index (BMI)
Calculated as weight in kilograms divided by the square of height in meters (kg/m\^2). BMI is used as an indicator of body fatness and weight management status. A lower BMI (within the healthy range) generally indicates better weight control outcomes.
Time frame: Baseline, Month 3, and Month 6
Change in Blood Pressure
Measured as Systolic and Diastolic Blood Pressure in mmHg using a standard sphygmomanometer. Lower blood pressure values (approaching the normal range) indicate better cardiovascular risk management.
Time frame: Baseline, Month 3, and Month 6
Incidence of Diabetes Complications
The occurrence of new or worsening diabetes-related complications, including but not limited to neuropathy, retinopathy, nephropathy, and cardiovascular events. Data will be collected through medical record reviews and patient self-reports. A lower incidence rate indicates better disease management
Time frame: Baseline, Month 3, and Month 6
Quality of Life (EQ-5D-5L)
Assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire. It covers five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Responses are converted into a single utility index score ranging from less than 0 to 1. Higher scores indicate better health-related quality of life.
Time frame: Baseline, Month 3, and Month 6
Self-Management Behaviors (SDSCA)
Assessed using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. This instrument measures the frequency of self-care activities (including diet, exercise, blood sugar testing, and foot care) over the past 7 days. Higher scores indicate better adherence to diabetes self-management activities.
Time frame: Baseline, Month 3, and Month 6
Treatment Satisfaction (DTSQs)
Assessed using the Diabetes Treatment Satisfaction Questionnaire (DTSQs). This tool evaluates the patient's satisfaction with their current treatment regimen, including perception of hyperglycemia/hypoglycemia and convenience. Higher scores indicate greater satisfaction with the treatment.
Time frame: Baseline, Month 3, and Month 6
Digital Literacy (C-eHEALS)
Assessed using the Chinese eHealth Literacy Scale (C-eHEALS). This scale measures the participants' combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems. Higher scores indicate higher levels of electronic health literacy.
Time frame: Baseline, Month 3, and Month 6
Medical Costs
Total direct and indirect costs related to diabetes management. Direct costs include expenses for examinations, medications, outpatient/inpatient visits, transportation, and caregiver fees. Indirect costs include caregiver time costs. Data will be collected via patient questionnaires and healthcare utilization records. Lower costs indicate a reduced economic burden.
Time frame: Baseline, Month 3, and Month 6
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