The goal of this clinical trial is to determine whether integration of vision care into the DM treatment system, by providing specific recommendations to doctors for management of diabetes alongside feedback on positive eye exams for DR can improve diabetes care outcomes.

The main questions it aims to answer are:

1. Does delivery of specific diabetes management recommendations to diabetes doctors for patients of theirs found to have DR lead to significantly improved blood glucose control as indicated by % reaching WHO targets of HbA1c (or targets for blood sugar if HbA1c data are unavailable)?
2. What is the cost-effectiveness of the intervention, measured as total intervention cost per additional participant reaching the WHO target?

Researchers will compare participant adherence with international guidelines when DR results are provided by a PIS without specific care recommendations to when the PIS provides DR results with specific care recommendations for DM management.

Inclusion Criteria:

• Diagnosed with DM
• Diagnosed with DR in at least one eye
• Over 30 years of age
• Currently treated at the Dinajpur Diabetes Hospital and Gausul Azam BNSB Eye Hospital in Bangladesh
• willingness to participate in the study

Exclusion Criteria:

• Any ocular condition impairing the view of the fundus sufficiently to preclude grading of the image for DR.
• Inability to comply with retinal photography to the extent that a gradable image cannot be captured, or any other factor leading to absence of sufficient images to grade at least one eye of a participant.
• Medical conditions that could impair compliance with follow-up (such as stroke, dementia, etc.)
• Unwilling to participate in the study, or incapable of giving informed consent.

de-identified data will be shared upon reasonable request to the corresponding author