nevertheless, developed nations such as those in the European Union or the United States are expecting an increase between 40% and 70% in the next 30 years, whereas growth in developing areas of the world, including Mexico, will be around 250% in the same period of time. Worldwide, Mexico has one of the most elevated type 2 diabetes mellitus prevalence. This survey shows a general prevalence of around 25% in the general population between 25 and 40 years of age [14]. The Mexican Survey of Chronic Diseases, performed in 1993, showed a general prevalence in the total Mexican population of 8.2% of type 2 diabetes mellitus and, in addition, almost one third of those diagnosed with the disease did not know they had it [15]. These high numbers are related to genetic predisposition [16, 17], in conjunction with increased life expectancy and the changes in human behavior and lifestyle that occurred in our country over the last century, which is associated with the demographic and epidemiologic transition discussed above [4, 18]. Type 2 diabetes mellitus has, in the last century, become a major cause of mortality in the Mexican population as well as the first cause of premature disability. Figure 3 shows the mortality related to diabetes mellitus in Mexico during the 8 eight decades. It is clear that the trend is moving to a continuous increase in mortality due to this disease; in 1992, the mortality rate was of 2.5 × 100,000 inhabitants, and for the year 1997 it was 15 times higher [18]. The Minister of Health of Mexico recently stated that this trend is expected to continue; deaths from diabetes frequently linked to obesity are increasing by 3% each year, and diabetes mellitus itself has become Mexico’s leading cause of death, representing 12% of total deaths in the country [19]. Prevention of diabetes complications The International Society of Nephrology held, in March 2004 at the Bellagio Study and Conference Center of the Rockefeller Foundation, a highly relevant workshop devoted to the discussion of strategies and actions directed toward the prevention of renal diseases in the emerging world. Discussion was focused mainly on S-72 Correa-Rotter and Gonzalez-Michaca: Diabetic nephropathy prevention in Mexico ´ 40 35 30 25 20 15 10 5 0 X 1000 inhabitants 1922 1930 1940 1950 1960 1970 1980 1990 1995 2000 Year O. Velàzquez M.A. Lara E., A, Peña C., La Diabetes en México, 2001 Fig. 3. Mortality related to diabetes mellitus in Mexico during the last decades. Adapted from [18]. pathogenetic issues associated with vascular injury, diabetes mellitus, and hypertension, epidemiologic analysis of different worldwide scenarios, and discussion of the burden of these diseases in the emerging world. In addition, early detection and preventive strategies that have been implemented, and other potentially useful ones, were discussed. The conference concluded that the actual trend of permanent increase in the incidence of diabetes mellitus and associated renal disease requiring renal replacement therapy is imposing a financial burden that cannot be met by most nations of the world. There is an urgent need for specific strategies and programs for early detection and prevention of vascular and renal complications of diabetes mellitus to avert the global threat of an uncontrolled pandemic. End-stage renal disease has indeed become a major health threat for the whole world, yet the steeper increase in its incidence and prevalence is happening in the developing world [2–5]. Over 1 million individuals who develop end-stage renal disease every year require expensive renal replacement therapy (dialysis or kidney transplantation). Non-insulin–dependent diabetes mellitus is by far the major contributor to this increase in end-stage renal disease. Worldwide, the increased prevalence of diabetes mellitus has expanded the premature mortality associated with disease due to a higher frequency of its complications [20, 21]. There is a clear need to implement diagnostic and treatment strategies to reduce those risk factors for the development of diabetes (primary prevention), to detect in early stages in patients that already have diabetes and are at risk of developing chronic complications (secondary prevention), and to prevent further progression of those that already have renal injury (tertiary prevention) [22]. We are also required to strongly promote an increase in the knowledge of risk factors as well as preventive measures in the general public, primary care physicians, government officials, and policy makers. The presence of urinary albumin excretion in patients with diabetes has been clearly identified as a risk indicator for nephropathy, cardiovascular injury, and death [22–24]. Microalbuminuria is one of the earliest markers of microvascular disease in the patient with diabetes, and it is widely accepted that it precludes development of overt albuminuria (>300 mg/day) and progressive renal functional deterioration. Microalbuminuria may also be associated with insulin resistance syndrome, and it is sometimes associated with conditions such as obesity and hypertension [25]. Medical procedures developed for preventing diabetic nephropathy must be viewed as limited in their effectiveness, because the exact pathogenic factors responsible for this condition are unknown. Some strategies that may slow the progression of renal disease include the