Xuxi Zhang

patients with type 2 diabetes. However, the study still has several limitations. First, no RCT included in our meta ‐ analysis was double ‐ blinded study. Second, in subgroup analyses, the number of studies in some subgroups (blood ‐ pressure ‐ control intervention, dietary ‐ control intervention and lipid ‐ control intervention) were small and there was a high level of heterogeneity in some subgroups (the groups of glycemic ‐ control intervention and follow ‐ up of over 5 years for the analysis on effect on DR progression). One possible reason of heterogeneity might be studies included in the analyses of DR progression did not provide distinctive data for new onset and worsening DR, and the variation between studies might be large. Third, subgroup analyses on the influence of other factors (e.g. duration of diabetes, duration of DR, intervention duration and frequency) could not be conducted due to the limited number of studies. Fourth, our meta ‐ analysis has not been registered online. Implications for practice and future researches We found that multifactorial interventions can significantly reduce the risk of developing DR and its progression among patients with type 2 diabetes. More importantly, we found all these multifactorial interventions contained individualization of targets and communication between health professionals and patients, suggesting ophthalmologists and diabetes health professionals should work together with patients to set more individualized targets while taking into account multiple factors so as to achieve optimal effect in DR prevention and control. Training on interventions on DR prevention and control should be carried out for general practitioners in primary level health facilities so that they can educate the patients with type 2 diabetes in this regard. In the future, guidelines on how to perform better and more effective DR prevention and control should be developed for general practitioners. In addition, more studies on the effectiveness of interventions targeting various modifiable risk factors of DR in prevention and control of DR are needed. 176 Chapter 7