Multi-targeted and aggressive treatment of patients with type 2 diabetes at high risk:: What are we waiting for?

Results from many single risk factor intervention trials and the multi-targeted Steno-2 trial in the last few years have provided a strong case that management of type 2 diabetes in all age groups requires a structured and intensified approach that is far more than just glucocentric, an approach addressing additional cardiovascular risk factors including hypertension, dyslipidaemia, sedentary behaviour, smoking and dietary habits causing insulin resistance and pro-inflammation. This type of integrated therapy applied for almost 8 years to high-risk type 2 diabetic patients has cut the relative risk of macro-and microangiopathy by half. The treatment algorithms for multifactorial therapeutic packages do not harbour any revolutionizing novel drugs or previously untested behaviour modelling, but the success criteria seem to include an individualized and stepwise introduction of target-driven polypharmacy and simple but focused behaviour modelling with continuous education, motivation and troubleshooting for treatment barriers identified for the patient and the care giver. It is high time we transfer these experiences and major health benefits gained in the 'green house' of controlled clinical trials to the community level. To facilitate this process it is of crucial importance to offer not only postgraduate training of diabetes care providers but also to identify and eliminate treatment barriers.