To assess country-level disparities, temporal trends, demographic drivers, and high fasting plasma glucose-attributable glaucoma burden in the Western Pacific Region from 1990 to 2023. Population-based observational study using secondary analyses of the Global Burden of Disease (GBD) database (1990–2023). Populations of countries and territories in the WPR; no individual-level participants or external control group. We extracted country-level estimates of glaucoma prevalence and disability-adjusted life years (DALYs) from GBD 1990–2023. Age-standardized rates (ASRs) were used to compare locations and time trends. Sex- and age-stratified analyses were performed. Decomposition analysis quantified the contributions of population growth, population aging, and epidemiologic change to changes in prevalent case numbers. Risk attribution analyses assessed the contribution of high fasting plasma glucose (HFP) to glaucoma DALYs. Glaucoma prevalence, DALYs, and their ASRs in the WPR; country-level heterogeneity; sex/age patterns; decomposition of case number changes; HFP-attributable burden. Marked heterogeneity in glaucoma burden was observed across the WPR, with the highest age-standardized burdens observed in Mongolia, the Philippines, Cambodia, and Viet Nam, and comparatively lower age-standardized rates in several island territories. Age-standardized trends were divergent: the age-standardized prevalence rate showed a modest overall increase, whereas the age-standardized DALY rate declined over time. In contrast, the absolute burden increased in many settings, reflecting the effects of population growth and aging. Older adults, particularly older women, represented key populations with a high glaucoma burden. Decomposition analysis indicated that population growth and aging were major drivers of increasing absolute burden. HFP-attributable glaucoma DALYs increased more rapidly in the WPR than globally, highlighting the potential value of integrating glaucoma prevention with chronic disease management. These findings provide updated regional evidence on glaucoma burden and its demographic and metabolic contributors in the WPR. Because disease burden alone does not determine prevention priorities, future planning should also incorporate economic burden, health-system capacity, access to eye care, and treatment coverage when designing country-specific glaucoma screening, referral, and long-term care strategies.

Background: Gestational diabetes mellitus (GDM) increases the risk of adverse neonatal outcomes, including preterm birth, macrosomia, neonatal hypoglycemia, and admission to the neonatal intensive care unit (NICU). While continuity of care has been shown to improve maternal health, its independent impact on neonatal outcomes remains insufficiently evaluated. Methods: A retrospective controlled study was conducted on 260 pregnant women with GDM treated at a tertiary hospital in Hubei Province, China (September 2020–June 2023). Participants were assigned to a control group receiving routine obstetric care (n = 60) or an intervention group receiving structured continuity of care (n = 200). The intervention included diet management, exercise therapy, psychological support, digital health education, and postpartum follow-up. Primary outcomes were neonatal indicators, including Apgar scores, preterm birth, macrosomia, low birth weight, neonatal distress, and NICU admission. Results: The continuity of care group showed significantly improved neonatal outcomes compared to the control group: preterm birth (3.0% vs. 23.3%, P<.001), macrosomia (0.5% vs. 15.0%, P<.001), low birth weight (1.0% vs. 21.7%, P<.001), Apgar score ≤ 7 at 1 minute (1.5% vs. 11.7%, P<.001), and NICU admission (9.0% vs. 56.7%, P<.001). Rates of neonatal organ injury, fetal distress, and amniotic fluid contamination were also significantly lower in the intervention group. Conclusion: Continuity of care significantly improves neonatal health in GDM pregnancies by reducing preterm delivery, abnormal birth weight, NICU transfer, and early neonatal complications. These findings suggest that continuity-based care should be integrated into routine GDM management to enhance perinatal outcomes and support mother-infant safety.

Sarcopenic obesity (SO), characterized by concurrent muscle loss and excess adiposity, is an emerging public health challenge, yet prospective evidence linking SO to mild cognitive impairment (MCI) remains limited. Baseline data were collected from the China Health and Retirement Longitudinal Study (CHARLS) in 2015. The incidences of MCI during follow-ups by 2018 and 2020 were calculated. Participants were divided into healthy, obesity only, sarcopenia only, and SO groups. Aging-associated MCI was defined as a total cognitive score at least one standard deviation below the age-specific norm for participants aged 45 and above, adjusted for age in five-year increments. In the 11,674 individuals with an average age of 59.31 ± 9.21 years, SO was detected in 160 (1.37

背景 基层医师在基层医疗卫生服务中发挥重要作用，临床实践指南是指导临床实践的重要工具，了解基层医师对指南的知悉程度与使用现状，可为基层指南推广与培训、提高基层医疗质量提供新思路。目的 调查、了解基层医师对糖尿病中医类指南的知悉程度与参考使用现状，并探讨其影响因素。方法 2021-09-22—10-29，通过线上调查方式向中华中医药学会糖尿病基层防治专家指导委员会发放电子问卷，并采用滚雪球抽样的方法 扩散至更多医师。问卷包括3部分：基本信息、医师使用中医药防治糖尿病现状与需求、医师对糖尿病指南认知现状与需求调查。采用有序多分类Logistic回归分析探讨基层医师对糖尿病中医类指南知悉程度与使用现状的影响因素。结果 共回收基层医师填写的有效问卷382份。35.34%(135/382)的医师对糖尿病中医类指南非常熟悉或比较熟悉，28.80%(110/382)的医师经常参考使用糖尿病中医类指南。单因素分析结果显示，不同性别、专业方向、所在科室、每周诊疗糖尿病患者数量、对中医药治疗糖尿病疗效评价、医师所在单位是否可以购买指南推荐的中药饮片或中成药、对指南知悉程度的基层医师对糖尿病中医指南参考情况比较，差异有统计学意义（P<0.05）。有序多分类Logistic回归分析结果显示，基层医师对糖尿病中医类指南知悉程度的影响因素为对中医药疗效评价为“非常有效”（OR=5.783,95%CI=1.283～26.102），医师所在单位可以购买指南推荐的中药饮片或中成药（OR=2.399,95%CI=1.548～3.717），既往接受过糖尿病防治指南的专题培训（OR=1.751,95%CI=1.149～2.667）3个因素；基层医师对糖尿病中医类指南参考情况的影响因素为医师对指南的知悉程度[非常或比较熟悉（OR=15.721,95%CI=7.584～32.557）、一般熟悉（OR=5.392,95%CI=2.841～10.237）]，工作年限≤5年（OR=14.083,95%CI=1.390～142.594），不同专业[中医专业（OR=6.869,95%CI=1.483～31.849）、中西医结合专业（OR=6.613,95%CI=1.551～28.219）]，不同地理区域[东北部（OR=2.962,95%CI=1.064～8.240）、东南部（OR=2.686,95%CI=1.004～7.178）]4个因素。结论 基层医师对糖尿病中医类指南的知悉程度和参考使用情况尚需提高。对指南的知悉程度、工作年限、专业方向、地理区域是影响医师参考使用指南的重要因素。今后应加强对基层医师的培训力度，尤其是对西北部和西南部地区、具有中医专业背景 的基层医师应加强中医防治糖尿病相关指南的培训。

OBJECTIVE:This study aims to investigate physicians' familiarity and awareness of four diabetes guidelines and their practice of the recommendations outlined in these guidelines.DESIGN:A cross-sectional study.SETTING:An online questionnaire survey was conducted among physicians affiliated with the Specialist Committee for Primary Diabetes Care of China Association of Chinese Medicine, using the snowball sampling method to ensure a broader representation of physicians.PARTICIPANTS:1150 physicians from 192 cities across 30 provinces in China provided complete data.RESULTS:Tertiary care hospital physicians (TCPs) exhibited the highest familiarity with the Guideline for the Prevention and Treatment of Type 2 Diabetes Mellitus in China (91.3%), followed by the National Guidelines for the Prevention and Control of Diabetes in Primary Care (76.8%), the Standards of Medical Care in Diabetes (72.2%) and the Guidelines for Prevention and Treatment of Diabetes in Chinese Medicine (63.8%). Primary care practitioners (PCPs) exhibited familiarity with these four guidelines at about 50% or less. Self-reported reference to modern diabetes guidelines by physicians is more frequent than traditional Chinese medicine (TCM) diabetes guidelines, with rates at 73.2% and 33.8%, respectively. Approximately 90% of physicians provided instructions on self-monitoring of blood glucose to their patients with diabetes. Less than one-third of physicians referred patients to a specialised nutritionist. In terms of health education management, TCPs reported having a diabetes health management team at the rate of 75.7%, followed by secondary care hospital physicians at 57.0% and PCPs at 27.5%. Furthermore, approximately 40% of physicians did not fully grasp hypoglycaemia characteristics.CONCLUSIONS:Familiarity and awareness of the screening guidelines varied among physicians in different hospital settings. Importantly, significant discrepancies were observed between physicians' awareness and their self-reported reference to modern medicine guidelines and TCM guidelines. It is essential to consistently provide education and training on diabetes management for all physicians, particularly PCPs.

美国糖尿病学会（ADA）在历年更新的《糖尿病医学诊疗标准》中一直强调“以患者为中心”理念的重要性，践行该理念有利于提高医疗服务效率和患者满意度、减少患者并发症发生、提升患者生命质量、降低患者医疗成本等。中医学素有“以人为本”的诊疗思想及丰富的个性化治疗手段，与ADA指南中“以患者为中心”的理念相契合。故该文基于ADA指南“以患者为中心”的理念，结合我国糖尿病防治现状，探讨我国糖尿病综合诊疗的发展思路，以期为我国糖尿病综合诊疗的完善和推广提供参考和可借鉴的经验。

"中西医并重"是我国糖尿病防治的重要策略和方针.为规范基层糖尿病诊疗,2022年3月中华医学会糖尿病学分会,国家基层糖尿病防治管理办公室共同发布了《国家基层糖尿病防治管理指南(2022)》,此次更新首次增加了糖尿病的中医药防治内容.笔者结合《中国2型糖尿病防治指南(2020)》,对指南中医药纳入背景和要点进行解读和对比分析,为临床应用提供参考.

BACKGROUND:Uncontrolled hyperglycemia, hypercholesterolemia, and hypertension are common in persons with diabetes.OBJECTIVE:To compare the effectiveness of team-based care with and without a clinical decision support system (CDSS) in controlling glycemia, lipids, and blood pressure (BP) among patients with type 2 diabetes.DESIGN:Cluster randomized trial. (ClinicalTrials.gov: NCT02835287).SETTING:38 community health centers in Xiamen, China.PATIENTS:11 132 persons aged 50 years or older with uncontrolled diabetes and comorbid conditions, 5475 receiving team-based care with a CDSS and 5657 receiving team-based care alone.INTERVENTION:Team-based care was delivered by primary care physicians, health coaches, and diabetes specialists in all centers. In addition, a computerized CDSS, which generated individualized treatment recommendations based on clinical guidelines, was implemented in 19 centers delivering team-based care with a CDSS.MEASUREMENTS:Coprimary outcomes were mean reductions in hemoglobin A1c (HbA1c) level, low-density lipoprotein cholesterol (LDL-C) level, and systolic BP over 18 months and the proportion of participants with all 3 risk factors controlled at 18 months.RESULTS:During the 18-month intervention, HbA1c levels, LDL-C levels, and systolic BP significantly decreased by -0.9 percentage point (95% CI, -0.9 to -0.8 percentage point), -0.49 mmol/L (CI, -0.53 to -0.45 mmol/L) (-19.0 mg/dL [CI, -20.4 to -17.5 mg/dL]), and -9.1 mm Hg (CI, -9.9 to -8.3 mm Hg), respectively, in team-based care with a CDSS and by -0.6 percentage point (CI, -0.7 to -0.5 percentage point), -0.32 mmol/L (CI, -0.35 to -0.29 mmol/L) (-12.5 mg/dL [CI, -13.6 to -11.3 mg/dL]), and -7.5 mm Hg (CI, -8.4 to -6.6 mm Hg), respectively, in team-based care alone. Net differences were -0.2 percentage point (CI, -0.3 to -0.1 percentage point) for HbA1c level, -0.17 mmol/L (CI, -0.21 to -0.12 mmol/L) (-6.5 mg/dL [CI, -8.3 to -4.6 mg/dL]) for LDL-C level, and -1.5 mm Hg (CI, -2.8 to -0.3 mm Hg) for systolic BP. The proportion of patients with controlled HbA1c, LDL-C, and systolic BP was 16.9% (CI, 15.7% to 18.2%) in team-based care with a CDSS and 13.0% (CI, 11.7% to 14.3%) in team-based care alone.LIMITATION:There was no usual care control, and clinical outcome assessors were unblinded; the analysis did not account for multiple comparisons.CONCLUSION:Compared with team-based care alone, team-based care with a CDSS significantly reduced cardiovascular risk factors in patients with diabetes, but the effect was modest.PRIMARY FUNDING SOURCE:Xiamen Municipal Health Commission.

Objective Studies have shown that sex differences in lean mass, concentrations of sex hormones, and lifestyles influence cle health and glucose metabolism. We evaluated the sex-specific association between low muscle mass and glucose fluctuations in hospitalized patients with type 2 diabetes mellitus (T2DM) receiving continuous subcutaneous insulin infusion (CSII) therapy. Methods A total of 1084 participants were included. Body composition was determined by dual-energy X-ray absorptiometry. Intraday blood glucose fluctuation was estimated by the Largest amplitude of glycemic excursions (LAGE) and standard deviation of blood glucose (SDBG). Results The prevalence of low muscle mass was higher in males than in females (p<0.001). There was a significant sex-specific interaction between the status of low muscle mass and glucose fluctuations (LAGE and SDBG) (p for interaction=0.025 and 0.036 for SDBG and LAGE, respectively). Among males, low muscle mass was significantly associated with a higher LAGE and SDBG (difference in LAGE: 2.26 [95% CI: 1.01 to 3.51], p < 0.001; difference in SDBG: 0.45 [95% CI: 0.25 to 0.65], p < 0.001) after adjustment for HbA1c, diabetes duration, hyperlipidemia, diabetic peripheral neuropathy, diabetic nephropathy, and cardiovascular disease. These associations remained significant after further adjustment for age and C-peptide. Among females, low muscle mass was not associated with LAGE or SDBG after adjustment for all covariates. Conclusion The prevalence of low muscle mass was higher in males than in females. Low muscle mass was significantly associated with higher LAGE and SDBG among males, but not females.

Review question / Objective: To evaluate the efficacy of electroacupuncture in the treatment of metabolic syndrome.Condition being studied: Metabolic syndrome (MS) is a state in which multiple diseases are clustered in the body, including hypertension, hyperglycemia, hyperlipidemia, and hyperuricemia, and its incidence is gradually increasing.The prevention and treatment of MS is a major international issue, and since MS and its complications are now internationally recognized as important risk factors for cardiovascular disease, the prevalence of metabolic syndrome has increased to the point of being considered an epidemic worldwide, especially in the last decade.In the United States, the prevalence of metabolic syndrome is estimated at 34% of the adult population.In addition, the growth rate of metabolic syndrome in developing countries is alarming.One can speculate that metabolic syndrome will have a huge impact on our lives.Acupuncture, as an external Chinese medical treatment, has been widely used in the treatment of metabolic syndrome.Electric acupuncture, buried thread, warm acupuncture, and ear acupuncture are all forms of acupuncture that play a role by stimulating acupoints.They are effective in the treatment of metabolic syndrome, easy to operate, and have no side effects.Therefore, this study used a meta-analysis to compare the efficacy of electroacupuncture on metabolic syndrome in order to provide some guidance for clinical treatment.

Introdution and Aims: The myokine irisin is critical to modulating adipocytes thermogenesis and influence whole-body metabolism. However, whether there is difference in the effects of irisin on adipocytes derived from different depots remains unknown, and the receptor of irisin on adipocytes is still unclear. In this study, we determine the browning effect of irisin on adipocytes of subcutaneous and visceral human adipose tissue and explore the possibility that integrin αV was the receptor of irisin on human adipocytes. Methods: Human adipose-derived stem cells were isolated from human subcutaneous and visceral white adipose tissues and induced to differentiate into mature adipocytes, and the expression of UCP1 and thermogenic genes in mature adipocytes were examined with or without irisin treatment and compared between groups of different adiposity and different spots. Immunoprecipitation analysis was used to detect the interaction between irisin and integrin αV on adipocytes, and the protein expression of integrin αV in adipocytes was also compared between groups of different adiposity and anatomic position. Results: Irisin treatment could increase the expression level of beige adipocyte marker protein UCP1 and specific thermogenic genes in mature adipocytes derived from subcutaneous white adipose tissue but not in visceral adipose tissue. The results of immunoprecipitation showed that irisin could be attached to integrin αV on mature adipocytes, and there was no significant difference in the gene and protein expression of integrin αV in adipocytes, either derived from subcutaneous and visceral adipose tissue, or derived from obese and normal-weight individuals. Conclusion: The results of the present study indicated that irisin contributed to the transformation of mature white adipocytes to beige adipocytes in human subcutaneous adipose tissue but not in visceral adipose tissue. Integrin αV may mediate the browning effects of irisin on human mature adipocytes, which could provide the potential therapeutic targets for obesity and metabolic syndrome by promoting human brown adipose tissue activity.

基层是糖尿病防控的重点，中医药是基层防控的重要方法之一。近日由中华医学会糖尿病学分会、国家基层糖尿病防治管理办公室组织修订的《国家基层糖尿病防治管理指南（2022）》正式发布。新版指南首次增设了“糖尿病的中医药防治”一章。本文对该指南的中医药内容进行解读，希望能更好指导临床，提高基层糖尿病中医药服务能力。

Abstract Background Sleep deprivation (SD) among young adults is a major public health concern. In humans, it has adverse effects on mood and results in serious health problems. Faced with SD, persons may take precautionary measures to try and reduce their risk. The aim of this study is to evaluate the efficacy and safety of electroacupuncture (EA) for the prevention of negative moods after SD. In addition, we will do a comparison of the effects of EA on mood after SD at different time points. Methods This randomized controlled trial (RCT) will be performed at the First Affiliated Hospital of Changchun University of Chinese Medicine in China. The Standards for Reporting Interventions in Clinical Trials of Acupuncture 2010 will be strictly adhered to. Forty-two healthy male volunteers will be distributed into acupoints electroacupuncture (AE) group, non-acupoints electroacupuncture (NAE) control group, or blank control group. This trial will comprise 1-week baseline (baseline sleep), 1-week preventative treatment, 30-h total sleep deprivation (TSD), and 24-h after waking follow-up period. Participants in the AE group and the NAE control group during the preventative treatment period will be administered with EA treatment once daily for 1 week. Participants in the blank control group will not be administered with any treatment. The primary outcome will be the Profile of Mood States (POMS) Scale. Secondary outcome measures will include changes in the Noldus FaceReader (a tool for automatic analysis of facial expressions) and Positive and Negative Affect Schedule (PANAS) Scale. Total sleep deprivation will be 30 h. During the 30-h TSD period, participants will be subjected to 11 sessions of assessment. Adverse events will be recorded. Discussion This study is designed to evaluate the efficacy and safety of EA for the prevention of negative moods after SD. The results of this trial will allow us to compare the effects of EA on mood after SD at different time points. Moreover, the findings from this trial will be published in peer-reviewed journals. Trial registration Chinese Clinical Trial Registry Chi2000039713 . Registered on 06 November 2020

Abstract Background: Functional diarrhea (FDr), one of the most common functional gastrointestinal diseases, is a kind of functional bowel disease characterized by repeated paste feces or watery feces. However, no relevant systematic review or meta-analysis has been designed to evaluate the effects of herbal acupoint application (HAA) on FDr. There is also a lack of systematic evaluation and analysis of acupoints and herbs. Methods: We will search the following 8 databases from their inception to October 15, 2021, without language restrictions: the Cochrane Central Register of Controlled Trials, PubMed, Embase, the Web of Science, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database, the Wan-Fang Database, and the China National Knowledge Infrastructure. The primary outcome measures will be clinical effective rate, functional outcomes, and quality of life. Data that meets the inclusion criteria will be extracted and analyzed using RevMan V.5.3 software (Available at: https://community.cochrane.org/help/tools-and-software/revman-5). Two reviewers will evaluate the studies using the Cochrane Collaboration risk of bias tool. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the overall quality of evidence supporting the primary outcomes. We will also use SPASS software (Version 19.0 (Available at: https://www.ibm.com/analytics/spss-statistics-software)) for complex network analysis to explore the potential core prescription of acupoint herbal patching for FDr. Results: This study will analyze the clinical effective rate, bristol stool scale, number of daily bowel movements, clinical symptom scale of diarrhea, and effective prescriptions of HAA for patients with FDr. Conclusion: The conclusion of our findings will provide evidence for the effectiveness and potential treatment prescriptions of HAA for patients with FDr.

BACKGROUND:Functional constipation is a common functional problem of the digestive system that has a negative impact on physical, mental health of patients and quality of life. At present, acupoint herbal patching as an adjuvant therapy is currently undergoing clinical trials in different medical centers. However, no relevant systematic review or meta-analysis has been designed to evaluate the effects of acupoint herbal patching on functional constipation. There is also a lack of systematic evaluation and analysis of acupoints and herbs. METHODS:We will search the following 8 databases from their inception to November 15, 2020, without language restrictions: the Cochrane Central Register of Controlled Trials, PubMed, Embase, the Web of Science, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database, the Wan-Fang Database and the China National Knowledge Infrastructure. The primary outcome measures will be clinical effective rate, functional outcomes, and quality of life. Data that meets the inclusion criteria will be extracted and analyzed using RevMan V.5.3 software. Two reviewers will evaluate the studies using the Cochrane Collaboration risk of bias tool. We will use the GRADE approach to assess the overall quality of evidence supporting the primary outcomes. We will also use Spass software (Version19.0) for complex network analysis to explore the potential core prescription of acupoint herbal patching for functional constipation. RESULTS:This study will analyze the clinical effective rate, functional outcomes, quality of life, improvement of clinical symptoms of functional constipation, and effective prescriptions of acupoint herbal patching for patients with functional constipation. CONCLUSION:Our findings will provide evidence for the effectiveness and potential treatment prescriptions of acupoint herbal patching for patients with functional constipation. PROSPERO REGISTRATION NUMBER:PROSPERO CRD 42020193489.

BACKGROUND:Primary dysmenorrhea (PD) is a functional disease of the female reproductive system, which has adverse effects on patients' physical and mental health and quality of life. At present, acupoint application of traditional Chinese medicine (TCM) as adjuvant therapy is undergoing clinical trials in different medical centers. However, there is no systematic review or meta-analysis to evaluate the efficacy of acupoint application of TCM in the treatment of PD. There is also a lack of systematic evaluation and analysis of acupoints and herbs. METHODS:All randomized controlled trials related to acupoint catgut embedding therapy on PD will be searched in the following electronic databases: Cochrane Central Registry of controlled trials, PubMed, Wed of Science, EMBASE, Science Net, China Biomedical Literature Database, China Science Journal Database, China National Knowledge Infrastructure and Wan-Fang Database, from inception to May, 2021 were searched without language restrictions. The primary outcomes contain visual analog score, The Cox Menstrual Symptom Scale, while the secondary outcomes consist of adverse events and the recurrence rate. Two reviewers will independently perform data selection, data synthesis, and quality assessment. Data meeting the inclusion criteria will be extracted and analyzed by Revman v.5.3 software. Two reviewers will evaluate the study using the Cochrane collaborative bias risk tool. We will use the scoring method to assess the overall quality of the evidence supporting the main results. We will also use Spass software (version 19.0) for complex network analysis to explore the potential core prescription of acupoint application of traditional Chinese medicine in the treatment of PD. RESULTS:This study will analyze the clinical effective rate, functional outcomes, quality of life, improvement of clinical symptoms of PD, and effective prescriptions of acupoint application for patients with PD. CONCLUSION:Our findings will provide evidence for the effectiveness and potential treatment prescriptions of acupoint application for patients with PD.PROSPERO registration number: CRD 42021244357.

Background Diabetes has become a major public health challenge worldwide, especially in low- and middle-income countries (LMICs). Uncontrolled hyperglycemia, hypertension, and dyslipidemia - major risk factors for all-cause mortality and cardiovascular disease (CVD) - are common in patients with diabetes in China. We propose to compare the effectiveness of team-based care plus a clinical decision support system (CDSS) with team-based care alone on glycemic, blood pressure (BP), and lipid control, and clinical CVD reduction among patients with type-2 diabetes and at high risk for CVD. Methods The Diabetes Complication Control in Community Clinics (D4C) study is a cluster-randomized trial conducted among 38 community health centers in Xiamen City, China. Nineteen clinics have been randomly assigned to team-based care plus CDSS and 19 to team-based care alone. Team-based care includes primary care providers, health coaches, and diabetes specialists working collaboratively with patients to achieve shared treatment goals for CVD risk factor reduction. The CDSS integrates guideline-based treatment algorithms for glycemic, BP, and lipid control, along with a patient's medical history and insurance policy, to recommend treatment and follow-up plans. In phase 1, the co-primary outcomes are mean reduction in glycated hemoglobin (HbA1c), systolic BP (SBP), and low-density lipoprotein (LDL)-cholesterol over 18 months, and the proportion of patients with controlled HbA1c, SBP, and LDL-cholesterol at 18 months' between the 2 comparison groups. In phase 2, the primary outcome is the difference in major CVD incidence (non-fatal stroke, non-fatal myocardial infarction, hospitalized heart failure, and CVD mortality) between the 2 comparison groups. Mean reduction in HbA1c, SBP, and LDL-cholesterol levels will be simultaneously modeled for a single overall treatment effect. Conclusion The D4C trial will generate evidence on whether a CDSS will further reduce the CVD burden among patients with diabetes beyond team-based care at community clinics. If proven effective, this implementation strategy could be scaled up within primary care settings in China and other LMICs to reduce CVD incidence and mortality among patients with diabetes.

Abstract Background: Functional constipation is a common functional problem of the digestive system that has a negative impact on physical, mental health of patients and quality of life. At present, acupoint herbal patching as an adjuvant therapy is currently undergoing clinical trials in different medical centers. However, no relevant systematic review or meta-analysis has been designed to evaluate the effects of acupoint herbal patching on functional constipation. There is also a lack of systematic evaluation and analysis of acupoints and herbs. Methods: We will search the following 8 databases from their inception to November 15, 2020, without language restrictions: the Cochrane Central Register of Controlled Trials, PubMed, Embase, the Web of Science, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database, the Wan-Fang Database and the China National Knowledge Infrastructure. The primary outcome measures will be clinical effective rate, functional outcomes, and quality of life. Data that meets the inclusion criteria will be extracted and analyzed using RevMan V.5.3 software. Two reviewers will evaluate the studies using the Cochrane Collaboration risk of bias tool. We will use the GRADE approach to assess the overall quality of evidence supporting the primary outcomes. We will also use Spass software (Version19.0) for complex network analysis to explore the potential core prescription of acupoint herbal patching for functional constipation. Results: This study will analyze the clinical effective rate, functional outcomes, quality of life, improvement of clinical symptoms of functional constipation, and effective prescriptions of acupoint herbal patching for patients with functional constipation. Conclusion: Our findings will provide evidence for the effectiveness and potential treatment prescriptions of acupoint herbal patching for patients with functional constipation. PROSPERO registration number: PROSPERO CRD 42020193489.