JMIR Publications

ABSTRACT

Background:

Diabetes mellitus (DM) is a major global public health burden, and achieving optimal glycemic control remains challenging. Multidisciplinary, hospital-wide glycemic management systems (HGMS) have emerged as a promising strategy. In the Chinese mainland, the adoption of HGMS has accelerated, yet substantial variations remain in system functionality, regional coverage, and management effectiveness across hospitals, underscoring the need for a national survey.

Objective:

This study aimed to survey the implementation patterns and functional needs for HGMS in the Chinese mainland.

Methods:

A mixed-methods design was employed, integrating a cross-sectional quantitative survey and qualitative interviews. From April 2024 to December 2024, healthcare professionals across 31 provincial-level administrative regions in the Chinese mainland were recruited. Data were collected using standardized questionnaires and purposive semi-structured interviews to evaluate the adoption, functional demands, and satisfaction with HGMS. Quantitative data were analyzed using SPSS 27.0. Differences in mean ratings across HGMS functions were evaluated using the Friedman test, with post hoc pairwise comparisons performed via the Wilcoxon signed-rank test and Bonferroni correction. Qualitative data underwent thematic analysis following Braun and Clarke’s framework, supported by NVivo 12.

Results:

A total of 988 healthcare professionals from 265 hospitals participated. HGMS implementation across hospitals in the Chinese mainland exhibited pronounced heterogeneity: 12.45% remained at Level 0 (handwritten glucose records), 47.92% at Level 1 (manual data entry), and 21.51% at Level 2 (department-level data sharing). Levels 3, 4, and 5 accounted for 13.21%, 3.40%, and 1.51%, respectively, revealing significant regional disparities. Functional demand analysis indicated consensus on the importance of basic HGMS functions, including real-time hypo-/hyperglycemia alerts (68.40%), Computerized Physician Order Entry-Electronic Medical Record (CPOE-EMR) interoperability (68.00%), and automatic glucose data transmission (67.50%). Among advanced functions, standardized diabetes education (64.50%), clinical decision support (61.50%), and tele-endocrinology consultation (61.10%) were also valued. Satisfaction was highest for automatic glucose data transmission (73.90%) and interoperability (63.70%), while clinical decision support received the lowest satisfaction (50.40%). The Friedman test indicated significant differences in perceived importance and satisfaction across the seven functions (χ²(6) = 89.895, 286.680, respectively, p<0.001). Post hoc analyses with Bonferroni adjustment revealed that participants ranked the relative importance and satisfaction of functions in distinct orders, with automated glucose data transmission consistently rated highest for both. Qualitative analysis revealed persistent barriers in non-specialist wards, including inadequate information integration, collaboration gaps, lack of risk stratification, and insufficient education and training.

Conclusions:

HGMS implementation in the Chinese mainland is transitioning from digitized glucose recording toward intelligent glycemic management. Future efforts should focus on establishing virtual wards for integrated care, developing dynamic glucose monitoring-guided management pathways, creating patient-centered collaborative platforms, and incorporating AI-enhanced clinical decision support to overcome existing barriers. Clinical Trial: None