Objective To explore the values of different clinical parameters and biochemistry indicators to monitor and predict diabetic retinopathy (DR). Methods The study involved 250 patients with type 2 diabetes mellitus (DM). The patients were divided into DR group (100 patients) with expected sensitivity (Sen) 80％, without DR group (150 patients) with expected specificity (Spe) 60％. DR related clinical and biochemical indicators which including peripheral blood plasma endothelin-1 (ET-1), peripheral vascular endothelial growth factor, plasma magnesium, renal function related indicators, islet function related indicators, blood rheology and blood lipids were detected. Receiver operating characteristic (ROC) was used to analyze accuracy; count the area under a curve (AUC), Sen, Spe and Youden index; develop joint diagnostic testing program. Results The parameters or indicators with clinical value of DR early warning included age, DM duration, plasma ET-1, serum magnesium and urinary albumin (P＜0.05). In the period of mild non-progressive DR, plasma ET-1 had the highest diagnostic validity (AUC=0.742,Spe=72.00%, Sen=72.20%); in moderate and severe non-progressive DR period, urinary albumin had the highest diagnosis validity (AUC=0.742, Spe=56.10%, Sen=87.88%); in the progressive DR period, the diagnostic validity of plasma ET-1 was highest (AUC=0.857, Spe=84.00%, Sen=85.71%). The joint program with the highest Youden index was DM duration combined with plasma ET-1 serial test, and the early warning value was that DM duration exceeded 3.5 years and the tested plasma ET-1 was greater than 160.00 pg/ml. Conclusions Age, DM duration, plasma ET-1, serum magnesium and urinary albumin are the significant parameters or indicators for DR early warning. Joint diagnostic tests can help patients to monitor the progression of DR.