Role-Playing–Based Physician Training and Metabolic Outcomes Among Patients With Type 2 Diabetes
Yifei Zhang, Ying Peng, Yufei Chen, Tingyu Ke, Fengmei Xu, Shengli Wu, Yuancheng Dai, Lin Sun, Qidong Zheng, Zhuomeng Hu, Qijuan Dong, Juan Shi, Xueyi Wu, Yu Shi, Rong Tang, Yubo Sha, Rongyue Chen, Bin Xu, Shu Li, Lianyong Liu, Mingdian Gao, Dong Zhao, Qinghua Yi, Zhiqiang Kang, Weiqing Wang, , Chao Liu, Jiaohong Luo, Yi Pan, Qiubo Zhao, Ying Huang, Xiaofeng Li, Xiaoyan Luo, Ke Su, Feifei Lai, Jinhua Yang, Jiwei Chen, Xiaoxue Chen, Zhuo Liu, Ping Wang, Jing Ke, Famei Li, Lei Li, Juan Xu, Jinhua Qian, Peipei Shen, Jiao Sun, Na Yi, Junhong Zhou, Xue Jia, Ling Hu, Xiaoling Yin, Shaohua Zheng, Aixue Wang, Aifang Wang, Shan Wu, Xiaolin Ye, Yuehong Lu, Shan Huang, Lili Xia, Yanling Feng, Hua Ju, Qian Zhang, Hongping Ao, Guihong Xing, Dan Qu, Wangjun Chen, Min Fang, Zhen Gu, Yun Chen, Zhimin Mei, Rongjun Gu, Jiye Liu, Miaomiao Hu, Mao Ye, Dan Gui, Cheng Wei, Huan Mai, Fafeng Sun, Weifeng Gong, Li Li, Ye Zhou, Jiansheng Niu, Feng Zhang, Xiaoshu Wang, Yihong Sun, Ying Yang, Xinqian Geng, Yongmei Li, Yang Liu, Jun Li, Ke Hai, Yan Liu, Jie Li, Liqiong Yan, Qun Zhou, Xiaohua Li, Jiawen Fu, Ping Feng, Mengdie Chen, Haiguang Zhang, Yanchao Gao, Bangqun Ji, Jingjing Li, Xiaoyue Xie, Ling Chen, Fanfan Zhu, Sheli Li, Xia Li, Yufan Wang, Haiyan Sun, Hongmei Qiu, Li Zhu, Huijuan Li, Haiyan Ye, Xiaoli Wu, Qiuhuan Xu, Lin Fu, Yunsong Li, Benyun Li, Fang Lv, Wei Si, Yue Tong, Qinpei Wang, Dongsheng Wang, Luping Zhang, Yongjun Jin, Liangyan Lin, Chunlei Deng, Yanming Shi, Lijun Wang, Haiying Tao, Yue Chen, Shiting Lu, Rihan Ao, Yuanyuan Li, Anhua Huang, Yonghua Huang, Yujian Zhu, Liyong Huang, Li Qin, Jie Yang, Zhengbo Fu, Xilai Zhao, Lan Liu, Yue Li, Jun Liao, Lijuan Hu, Wenling Su, Fang Miao, Yikui Lv, Ying Wang, Xiaodong Zhao, Hui Yu, Hongxia Zhao, Na Zhang, Tongqin Yuan, Yelei Li, Jieji Zhang, Binbin Li, Youqiang Yang, Tao Li, Haitao Zhang, Ping Fan, Xueyong Lou, Yingting Chen, Yanmei Yu, Zhihui Gao, Zunhai Zhou, Xiaoyan Zhang, Caifeng Qian, Fanguang Meng, Xiaoju Qi, Yao Li, Bo Yan, Yuan Yao, Wen Xu, Qibin Mao, Linjin Wu, Sheng'ai Shen, Lian Cui, Jinsong Kuang, Juan Qin, Ping Liu, Ting Wang, Zhihong Zeng, Beibei Wang, Chunxiao Shi, Yun Pu, Guoqing Liu, Shanshan Zhang, Aiming Zhang, Chengcheng Ye, Riqiu Chen, Changrong Guan, Junjie Shang, Xinqiong Liu, Yan Liang, Xuejiang Gu, Lijuan Yang, Hongyan Shu, Manyun Gao, Li Wang, Yingcun Chen, Yan'e Liu, Xiaorong Liu, Qin Tao, Xinhua Ye, Xiaoqing Yuan, Huishu Yang, Chunli Piao, Shengnan Gao, Yuan Tian, Dongxue Su, Pan Yin, Wenjuan Deng, Hongwei Luo, Weiping Tu, Linfei Zhang, Lanrong Li, Tingting Li, Dan Wu, Qi Zhao, Qianqian Sun, Qing Wang, Yan Shi, Jing Wang, Weici Xie, Jin'e Xu, Yunping Zhang, Yanhua Lu, Ping Zhang, Xiaofang Shen, Ling Li, Yuexing Yuan, Yan Li, Jing Zhou, Jiaying Zhao, Yuan Chai, Chunfang Wen, Jiatao Zhang, Wei Wang, Yi Zhang, Xiaohua Yang, Lin Wu, Xia Mei, Yuping Wang, Kun Yang, Mingbin Liu, Sha Li, Xiaoming Du, Pixiu Hou, Hongjun Fu, Yuan Lin, Hongji Wu, Ying Li, Yunxia Chen, Chunjing Zhu, Zhaoyang Xu, Jun Xia, Pei Gu, Haiyan Meng, Wei Du, Xu Cao, Xunxiong Zang, Dandan Zhao, Hongbin Zhu, Lijuan Zhong, Liu Yang, Hui Zhang, Shuhui Yang, Yifeng Cai, Lifei Zhang, Tingzhi Li, Hong Liu, Feng Wei, Lijue Ren, Wukun Ma, Yongzhi Wang, Lixia Suo, Xiaou Chen, Yinli Huang, Wei Dong, Yezi Sun, Mengjie Tang, Wenhao Wei, Chao Zheng, Wenheng Zeng, Wei Li, Lu Liang, Tianying Xu, Shunyuan Ming, Yan Wang, Xue Wang, Huaqing Pang, Liyin Mu, Yi Shu, Jielong Tang, Binhong Duan, Chaofeng Xiang, Lan Xu, Wei Shi, Wenxia Li, Fei Wu, Yingli Dai, Qiang Lu, Shenglian Gan, Haifeng Zhou, Jun Zhang, Minmin Guo, Ying Cao, Lingling Lv, Yongqiang Zheng, Biqian Liang, Binbin Tian, Yanfeng Yang, Yan Feng, Xuan Wang, Liujun Fu, Jianlong Hu, Shouqing Zhang, Jie Zhang, Xun Gao, Yuling Zhao, Lei Chen, Ying Wu, Xiaohong Wu, Ye Hu, Ming Xu, Guiyan Chen, Lu Cui, Zhaoliang Li, Yue'e Li, Yao He, Jie Ning, Qingxian Li, Yahong Ma, Yanrong Li, Jianting Wu, Manfei Zheng, Shuibing Yang, Ling Zhang, Haiyan Dai, Yuting Zhang, Yugang Hu, Yirong Huang, Hong Yang, Enling Ye, Miao Jiang, Fang Li, Fang Yao, Li Xu, Fuyuan Zhuge, Tiantian Lu, Xingjian Zhou, Fei Li, Xueqin Wang, Jiqing Shi, Cuihua Liu, Lu Wang, Mingde Liu, Zhigang Guo, Zhihua Jiang, Yifeng Yao, Yanfang Zhang, Yaoyi Zhang, Mingjun Gu, Jiancan Lu, Mianjiong Wang, Chang Lin, Dianrong Jia, Yanwen Chen, Huijuan Ma, Xiju Jia, Baiyun Li, Guangrong Zou, Ning Xu, Zhichen Zheng, Xiusheng Cheng, Xiuwei Zhang, Han Cui, Xin Yan, Haijing Qin, Shuguang Feng, Kai Lou, Feng Li, Wenjun You, Yanhui Pan, Xichen Liu, Liya Liao, Yawei Zhang, Xing Pan, Fengmei Zhang, Peng Liu, Bi Lu, Mengting Li, Shujin Wang, Ting Qi, Libo Yu, Xiujun Yan, Yong Meng, Na XuImportance
Global glycemic control in diabetes is suboptimal, with persistent gaps between guideline recommendations and clinical practice.
Objective
To evaluate the effectiveness of a role-playing–based intensive training program for physicians in improving glycemic control among patients with type 2 diabetes.
Design, Setting, and Participants
This was an open-label, 2-arm parallel, cluster randomized clinical trial conducted at 205 centers in China, with enrollment from February 13 to September 19, 2023, and 12-month follow-up completed on October 25, 2024. In phase 1, 205 physicians from qualified diabetes centers across China were enrolled from February 13 to April 29, 2023, and randomly assigned to the intensive training group (n = 103) and the regular training group (n = 102). In phase 2, 2017 patients with type 2 diabetes were enrolled from February 28 to September 19, 2023. Data were analyzed from January 1 to June 1, 2025.
Interventions
One-week on-site role-playing–based intensive training (involving simulating patient roles in experiencing diabetes-related health examinations, complication scenarios, lifestyle intervention, and face-to-face conversations) vs regular training.
Main Outcomes and Measures
The proportion of patients achieving a hemoglobin A 1c (HbA 1c ) level of less than 7.0% at 6 months. The primary analysis was based on the intention-to-treat principle.
Results
A total of 205 physicians (mean [SD] age, 36.2 [5.1] years; 155 women [75.6%]) and 2017 patients (mean [SD] age, 53.0 [7.0] years; 713 women [35.3%] and 1304 men [64.7%]) were enrolled, with 1009 patients in the intensive training group and 1008 patients in the regular training group. At 6 months, a significantly greater proportion of patients in the intensive training group achieved an HbA 1c level less than 7.0% compared with the regular training group (58.0% [476 of 820] vs 42.9% [351 of 818]), with an adjusted between-group difference of 16.6% (95% CI, 7.2%-25.7%; P < .001). At 12 months, the difference between the intensive training group and the regular training group remained significant (60.9% [502 of 824] vs 44.6% [371 of 832]; adjusted between-group difference, 17.0% [95% CI, 7.0%-26.8%]; P < .001). The intensive group had greater reductions in body mass index (adjusted between-group difference, −0.3 [95% CI, −0.5 to −0.1]), waist circumference (adjusted between-group difference, −1.4 cm [95% CI, −2.1 to −0.8 cm]), fasting glucose (adjusted between-group difference, −6.3 mg/dL [95% CI, −10.7 to −1.9 mg/dL]), and systolic blood pressure (adjusted between-group difference, −1.5 mm Hg [95% CI, −2.9 to −0.1 mm Hg]). Serious adverse events were comparable between groups (intensive group, 2.6% [26 of 1009]; regular group, 2.4% [24 of 1008]).
Conclusions and Relevance
In this cluster randomized clinical trial of role-playing–based intensive training for physicians managing type 2 diabetes, the intervention significantly improved patient glycemic control. These findings suggest a feasible strategy to narrow the guideline-implementation gap in diabetes care.
Trial Registration
ClinicalTrials.gov Identifier: