the steno-2 study, which embraced such a multifactorial approach to treatment, demonstrated impressive reduction in vascular complications. in this randomised study of only 160 patients with type 2 diabeted and microalbuminuria, half of the patients received intensive target-driven therapy based in a hospital clinic and the remaining patients were cared for in primary care according to national guidelines. the main results of the stydy are presented in table 2. while providing evidence for effectiveness, the translation of this approach to large numbers of patients in already stretched healthcare systems presents an additional challenge.