[Intensive care of type 2 diabetes: what does the STENO 2 study teach us?]

In medicine, as in hard science, what seems to us to be obvious should still be proven. The Steno 2 study confirmed what we had always thought to be obvious: In patients with type 2 diabetes, the intensive treatment of all cardiovascular risk factors reduces the rate of cardiovascular complications by more than 50%. However, achieving these ambitious targets corresponds to idealism rather than clinical reality. Only 15% of the patients in the multi-intensive group achieved an HbA1c below 6.5% and only 70% achieved a cholesterol level of less than 4.5 mmol/l or a diastolic blood pressure of below 80 mmHg. The therapeutic targets of the Steno 2 study should be used more as a guide than as absolute law. The Steno 2 team used different tools to achieve these results: combined treatments, individualized objectives, motivation groups with the participation of the spouse, and long term objectives. To transfer such a program into a GP's day to day practice demands a great deal of work: development of network strategies, initiation of therapeutic education in the field, and a better understanding of available resources and motivation.