The Steno-2 Study,(8) which embraced such a multifactorial approach to treatment, demonstrated impressive reductions in vascular complications. In this randomized study of only 160 patients with type 2 diabetes and microalbuminuria, half of the patients received in tensive 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 study are presented in table II. While providing evidence for effectiveness, the translation of this approach to large numbers of patients in already stretched healthcare systems presents an additional challenge.