Primary medical and health institutions should undertake the health education, screening, diagnosis, treatment and long-term follow-up management of diabetes, and find diabetic patients who are not suitable for primary diagnosis and treatment and refer them in time. The goal of diabetes management in primary medical and health institutions is to control blood sugar, blood pressure and blood lipid to reach the standard, reduce the occurrence of complications, and reduce the disability rate and premature death rate.
Diabetes health management service combined with family doctor contract service system provides patients with all-round, continuous and responsible medical health management services. Establish cooperation mechanism with superior hospitals to realize two-way referral.