The high prevalence of diabetes in Australia, which reflects worldwide trends, is a major public health problem because people with diabetes are prone to develop cardiovascular, eye, kidney and foot complications.  Furthermore, a substantial proportion of the direct health costs associated with the care of a patient with diabetes is related to management of their diabetes related complications. The standard of care for patients at high risk for the development and progression of renal and vascular complications, at least for those with type 2 diabetes, has been established by the Steno-2 study, published in 2003.  This showed that after approximately eight years of multipronged, aggressive target driven management, the risk of cardiovascular events was reduced by approximately 50 %.  The event rates for microvascular complications, namely the development and progression of macroalbuminuria, retinopathy and autonomic neuropathy, were also reduced by a similar magnitude.  After the interventional arm of the study was completed, patients were subsequently followed for a further 5 years.  At the end of this observational period, patients who were originally randomised to intensive, multifactorial interventions had a significant reduction in mortality, mainly due to a reduction in cardiovascular deaths, progression to end-stage kidney disease, and the need for retinal photocoagulation.  This presentation will review the results of recent major “post-Steno-2” clinical trials designed to test the effectiveness of target driven strategies, mainly focusing on glycaemic and blood pressure targets, or specific interventions aimed at reducing the development and progression of diabetes related complications.  The potential of interventions that involve the use of anti-VEGF agents, blockers of the renin-angiotensin system, defined combinations of blood pressure lowering agents, fenofibrate and bardoxolone will be discussed.