Through the systematic analysis of the current research results on the effectiveness of traditional Chinese medicine（TCM） in the prevention and treatment of diabetes and its promotion dilemma， it is believed that cohort study， as an observational research method， is particularly suitable for evaluating complex and individualized interventions such as traditional Chinese medicine in the prevention and treatment of diabetes. Considering the design features and relevant practices of prospective cohort studies， it is specifically proposed to carry out prospective cohort studies using a modern TCM diagnostic and treatment system for diabetes， centered on "state-targeted differentiation and treatment"， and framed by "classification-staging-syndrome differentiation". Focused on personalized prevention and treatment， long-term multidimensional assessment of therapeutic effectiveness and syndrome changes， this paper gives in-depth exploration of the advantages and value of applying prospective cohort studies in the effectiveness evaluation of TCM in prevention and treatment of diabetes， aiming to provide insights for clinical researches on TCM for diabetes.