Abstract: Objective To explore and evaluate the mode of integrated intervention in diabetic eye disease by general service team. Methods Integrated intervention for prevention and treatment of blindness and health education were carried out by general service team through a 2-year prospective cohort study. The evaluation was made with the indicators such as mastery of health knowledge, ability of disease management, laboratory parameters change, vision improvement and changes of diabetic retinopathy. Results It was found that 8 items on health knowledge, 6 items on ability of disease management,3 laboratory parameters and condition in the control of visual impairment and diabetic retinopathy were all better in the intervention group than in the control group. Conclusion The effect of integrated intervention mode is significant by general practitioners and specialists participating in chronic disease prevention network.