Comprehensive Intervention and Outcome Assessment among High-Risk Populations for Diabetic Retinopathy

INTERVENTION: Intervention group:Multidisciplinary team establishment and training; High‐risk population risk stratification management (based on baseline fundus screening results, divided into negative, routine positive, and severe positive risk levels, followed up every 3 months, every 2 months, and every 1 month respectively, with a follow‐up period of 6 months); Health monitoring and health guidance (face‐to‐face visits, blood pressure and blood glucose measurement, medication record, ocular symptom inquiry, verification and correction of medication behavior, distribution of personalized health education cards, health education and lifestyle guidance); Specialty support and referral guarantee (specialty physician re‐evaluation of diagnosis, development of individualized treatment plans, urgent referral pathway for severe positive individuals, downward referral to primary care for those with stable condition);Control group:Based on the requirements of type 2 diabetes patient health management services in the National Basic Public Health Service Standards, provide routine management services; CONDITION: Diabetic Retinopathy PRIMARY OUTCOME: HbA1c;Fasting Blood Glucose;Incidence of Diabetic Retinopathy; SECONDARY OUTCOME: Health‐Related Behaviors;Health and Quality of Life;Visual Function Quality of Life; INCLUSION CRITERIA: 1. Age 35 or older; 2. Patients with a confirmed diagnosis of type 2 diabetes who have any one of the following risk factors: duration of diabetes >= 5 years; HbA1c >= 7.0%; concomitant hypertension, dyslipidemia, or obesity; or the presence of other chronic complications of diabetes; 3. Willingness to sign the informed consent form for the study.