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S6 Table exhibits a real example of the monthly performance report for 24 counties in September 2018. To our knowledge, ROADMAP is the largest randomized controlled trial in testing the effectiveness and safety of an mHealth-based diabetes management with a diverse coverage of primary care settings. After 1-year follow-up, we found that the intervention lowered the HbA1c level by 0. We also observed an absolute improvement in agriculture system intervention group agriculture system the composite cardiometabolic ABC control rate of 1.

The increased control of FBG and BP and the reduced levels of FBG and DBP favored the intervention as well. No increasing episodes of hypoglycemia and weight gain were found to be associated with the intervention.

The findings indicate that integrated mHealth solution, which facilitates blood glucose monitoring and performance evaluation, could be effective and safe in improving diabetes control in primary agriculture system settings.

Regular blood glucose monitoring is the basis for optimized diabetes management. The minimum requirement of 4 blood glucose tests for each patient per year by the BPHS in China has been an improvement in universal agriculture system of diabetes management, but it is far from enough. Our study showed that a slight increase in the frequency of blood glucose monitoring was accompanied by other behavior change make a decision better glycemic control.

Persistent uncontrolled glycemic level is one of the referral indications as per the Chinese agriculture system guideline. However, the average referral frequency found in the intervention group of the ROADMAP study was only 0. The pooled result showed a mean HbA1c reduction by 0. Acknowledging the difficulties in implementing complex intervention in diverse context, we adopted several strategies to increase intervention fidelity, including clarifying intervention flowchart using table stickers, providing remote trainings and reminders through WeChat, and real-time access to performance report and ranking through a designated website portal.

Even with above strategies, the intervention delivery remained inadequate. Based on the app records, the frequency of blood glucose test was 18. The ROADMAP study presents several strengths. First, this study has a diverse coverage of 864 communities across 25 Chinese provinces. It provides an opportunity to explore context impact and make context-fitting adaptation agriculture system future scale-up.

Secondly, the participants in agriculture system ROADMAP study were randomly selected from all patients registered in the studied communities. The representative sampling enhances the generalizability of the findings. Furthermore, the centrally distributed HbA1c analyzers for point-of-care testing guarantees the accuracy and consistency of the primary outcome throughout such a large study.

There are several limitations in the ROADMAP study. Apart from HbA1c, other physical and biochemical examinations were conducted using various local resources, although quality requirements had been met during site selection. Third, we underestimated the agriculture system of blood glucose monitoring in usual care, which resulted in a relatively small improvement in frequency agriculture system blood glucose monitoring agriculture system our study.

A larger effectiveness on diabetes control might be achieved if more frequent individualized blood agriculture system and BP tests were adopted. Potential bias and low statistical power made it unreliable agriculture system detect the effectiveness of Your Doctor. In conclusion, the primary care system in China, as in other LMICs, is struggling to meet the gaps in chronic disease management, including diabetes, and innovative solutions are needed.

The ROADMAP study offers a supportive and collaborative solution to tackle the suboptimal diabetes control in primary care via an integrated mHealth-based platform.

More interactive health education to raise the awareness of the importance of treat to target for both patients and community doctors, more agriculture system engagement of upstream hospital doctors, leveraging home-tested glucose data to support diabetes management, and adding individualized medication guide agriculture system the mHealth platform may further improve the effectiveness of such an mHealth platform.

We expect agriculture system the findings from the ROADMAP study could inform the improvement of the BPHS programs and promote effective and rational use of limited healthcare resource in China and other LMICs.

Appreciation for the support from trial steering committee and efforts made by the ROADMAP Study Group, all participating agriculture system research associates, investigators, doctors, and patients, as well as those who helped to facilitate trial preparation, execution, and evaluation.

The ROADMAP Study Group was composed by Dalong Zhu, Agriculture system Li, Guangyao Song, Haoming Tian, Hong Li (Zhejiang Province), Hong Li (Yunnan Province), Hongyu Kuang, Huili Zhang, Jianying Liu, Jie Liu, Jing Liu, Li Bayer health animal, Li Yuan, Liming Chen, Lixin Shi, Minxiang Lei, Ping Liu, Puhong Zhang, Qifu Li, Qiu Zhang, Qiuhe Ji, Yadong Sun, Yanbing Li, Yuqian Bao, Yuzhen Liang, Weiping Jia, Zhigang Zhao, Zhongyan Shan, and Zilin Sun, alphabetically ordered by given name.



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