(1) Satisfied with blood sugar control (fasting blood sugar value
(2) For the first time, the patients with unsatisfactory fasting blood glucose control (fasting blood glucose value ≥7.0mmol/L) or adverse drug reactions were instructed according to their medication compliance. If necessary, increase the dosage of existing drugs, replace or increase different hypoglycemic agents, and follow up within 2 weeks.
(3) For patients who are dissatisfied with the control of fasting blood glucose for two consecutive times or whose adverse drug reactions are difficult to control, and have new or aggravated complications, it is recommended to refer them to higher-level hospitals, and actively follow up and refer them within 2 weeks.
(4) Carry out targeted health education for all patients, work out lifestyle improvement goals with patients, and evaluate the progress at the next follow-up. Tell the patient to see a doctor as soon as anything goes wrong.
Intervention is mainly divided into the following five points: 1, patient basic knowledge education; 2. Psychological consultation for patients; 3. Diet and exercise guidance; 4, drug therapy and blood sugar monitoring guidance; 5, prevention and guidance of complications. Diabetic foot, eye disease, ED, neuropathy, etc.