 The overall objective of the proposed cluster randomized trial is to test whether implementation of protocol-based integrated care will improve CVD risk factors glycated hemoglobin HbA1C, systolic blood pressure SBP, and LDL-cholesterol over 18 months and reduce major CVD events non-fatal stroke, non-fatal myocardial infarction, hospitalized heart failure, and CVD mortality over 3 years among patients with type 2 diabetes and additional CVD risk factors or clinical CVD compared to usual care in community clinics in Xiamen, China. 