We carried out a randomized trial of stepwise intensive treatment or standard treatment of risk factors in patients with type 2 diabetes and microalbuminuria. Patients were allocated standard treatment (n = 80) or intensive treatment (n = 80). Intensive treatment was a stepwise implementation of behaviour modification, pharmacological therapy targeting hyperglycaemia, hypertension, dyslipidaemia, and microalbuminuria. The primary endpoint was development of nephropathy. Secondary endpoints were incidence or progression of diabetic retinopathy and neuropathy. Patients were followed for 3.8 years. The intensive group had significantly lower rates of progression to hephropathy (odds ratio 0.27 [95% CI 0.10-0.75]), progression of retinopathy (0.45 (0.21-0.95]), and progression of autonomic neuropathy (0.32 [0.12-0.78]). In conclusion, intensified multifactorial intervention in patients with type 2 diabetic mellitus and microalbuminuria has beneficial effects on long-term complications.