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Clinical Review State of the Art Review

How to prevent the microvascular complications of type 2 diabetes beyond glucose control

BMJ 2017; 356 doi: (Published 17 January 2017) Cite this as: BMJ 2017;356:i6505

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This article has a correction. Please see:

  1. Willy Marcos Valencia, voluntary assistant professor, physician scientist, (geriatric medicine – endocrinology, diabetes and metabolism)12,
  2. Hermes Florez, director, professor, chief234
  1. 1Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33125, USA
  2. 2Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA
  3. 3Departments of Public Health Sciences and Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
  4. 4Division of Epidemiology, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
  1. Correspondence to: W M Valencia willy.valencia-rodrigo{at}


Microvascular complications (retinopathy, nephropathy, and neuropathy) affect hundreds of millions of patients with type 2 diabetes. They usually affect people with longstanding or uncontrolled disease, but they can also be present at diagnosis or in those yet to have a diagnosis made. The presentation and progression of these complications can lead to loss of visual, renal, and neurologic functions, impaired mobility and cognition, poor quality of life, limitations for employment and productivity, and increased costs for the patient and society. If left uncontrolled or untreated, they lead to irreversible damage and even death. This review focuses on the primary and secondary prevention of diabetic microvascular complications in patients with type 2 diabetes, beyond glycemic control. Interventions discussed include standard of care interventions supported by guidelines from major organizations, as well as additional proposed interventions that are supported by research published in the past decade. High level evidence sources such as systematic reviews and large, multicenter randomized clinical trials have been prioritized. Smaller trials were included where high quality evidence was unavailable.


  • Contributors: WMV and HF engaged with BMJ editors for the planning, outline, and scope of this review. Both authors participated in the search and selection of publications, analysis and interpretation of data, and submission of the manuscript. WMV modified the manuscript following suggested by reviewers, with input from HF. WMV is the guarantor.

  • Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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