Limited evidence suggests that multifactorial interventions for control of glucose, blood pressure, and lipids reduce macrovascular complications and mortality in patients with type 2 diabetes. However, safe and effective treatment targets for these risk factors have not been determined for such interventions. In this multicentre, open-label, randomised, parallel-group trial, undertaken at 81 clinical sites in Japan, we randomly assigned (1:1) patients with type 2 diabetes aged 45-69 years with hypertension, dyslipidaemia, or both, and an HbA1c of 6.9% or higher, to receive conventional therapy for glucose, blood pressure, and lipid control or intensive therapy. This study is registered with ClinicalTrials.gov, number NCT00300976. During the intervention period for a median of 8.5 years, mean HbA1c, systolic blood pressure, diastolic blood pressure, and LDL cholesterol concentrations were significantly lower in the intensive therapy group than in the conventional therapy group (6.8% vs 7.2% ; 123 mm Hg vs 129 mm Hg; 71 mm Hg vs 74 mm Hg; and 85 mg/dL vs 104 mg/dL, respectively; all p < 0.0001). The primary outcome occurred in 109 patients in the intensive therapy group and in 133 patients in the conventional therapy group (hazard ratio [HR] 0.81, p = 0.094). In a posthoc breakdown of the composite outcome, cerebrovascular events (stroke, carotid endarterectomy, percutaneous transluminal cerebral angioplasty, and carotid artery stenting) were significantly less frequent in the intensive therapy group (HR 0.42, p = 0.002).Moreover, renal events were also significant less frequent in intensive therapy group (HR 0.68, p < 0.0001). Apart from non-severe hypoglycaemia (521 [41%] patients in the intensive therapy group vs 283 [22%] in the conventional therapy group, p < 0.0001) and oedema (193 [15%] vs 129 [10%], p = 0.0001), the frequencies of major adverse events did not differ between groups. Our findings suggest a potential benefit of an intensified intervention for the prevention of cerebrovascular and renal events in patients with type 2 diabetes.