maintenance of good glycemic control [26–28] and blood pressure control, the limiting of protein intake [29–31], changes in lifestyle including smoking cessation, prompt treatment of urinary tract infections, and the avoidance of potentially nephrotoxic drugs and radiographic dyes [32]. Since the last decade, it has been well established that intensive control of blood glucose can prevent retinal, renal, and neuropathic complications of type 1 and 2 diabetes. The Diabetes Control and Complications Trial [28] and the United Kingdom Prospective Diabetes Study [33] were the first of several studies that established the value of intensive control of blood glucose. Establishment of intensive glucose control has demonstrated a reduction in albuminuria (surrogate end point) and a prevention or retardation in the development of diabetic nephropathy leading to end-stage renal disease (actual end point) [34, 35]. Correa-Rotter and Gonzalez-Michaca: Diabetic nephropathy prevention in Mexico ´ S-73 Diabetic renal disease is accompanied by the development of hypertension in almost all patients, and it is well known that antihypertensive treatment delays progressive renal injury [36]. Several studies have demonstrated that the blockade of the renin-angiotensin system (RAAS) with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers is of additional benefit. RAAS-blocking agents administered either in early or later stages of the disease may induce a beneficial effect in terms of reduction of microalbuminuria and subsequent reduction of progressive renal injury [36–41]. The pathophysiologic participation of the RAAS in renal injury of diabetic renal disease, and the subsequent implementation of pharmacologic interventions to block this system, have modified our ability to treat the patient with diabetes with nephropathy. It is clear that the beneficial renoprotective effect of the RAAS blockade is, in part, independent of the antihypertensive mechanism and may induce reduction or regression of microalbuminuria in early states of renal injury, even in the absence of hypertension. The fact that microalbuminuria is an early marker of renal injury has allowed its application as a monitoring instrument of early stages of the disease [25, 31, 35, 37], and the timely identification of diabetics that can benefit from the renal protective effects of blockade of the RAAS system and other preventive measures. Given the extremely high costs of renal replacement treatment for end-stage renal disease as well as that of other cardiovascular complications, it is clear that this procedure may be highly cost-effective and an invaluable aid to mitigate the very large financial burden of treating end-stage renal disease. It may also favor better patient outcomes in countries of the developing world [29–31, 34]. Actually, we believe that this approach may be the way of the future, in terms of control of an epidemic growth of diabetes mellitus, diabetic nephropathy, and other chronic vascular diseases. It is clear that preventive actions must be implemented as early as possible in the evolution of diabetes; however, multiple situations have precluded timely actions. Some of the most relevant are the absence of overt symptoms in most patients, lack of health-related education of the general population, lack of knowledge of primary care physicians about the importance of preventive measures, lack of commitment by the medical community, delayed referral to nephrologists and, of course, scarce resources for preventive medicine from national health systems [42]. Development and execution of successful preventive programs require joint efforts that include the participation of patients and their relatives, physicians and other health workers, national government agencies, the pharmaceutical industry, and international agencies. Of utmost importance is to raise awareness and to educate the general public, patients, policymakers, and primary physicians in charge of patients on the importance of generating changes in lifestyle conditions that may reduce the risk of development of chronic conditions, and on those simple maneuvers directed to early detection of risk factors. In parallel with educational efforts, we need effective programs geared toward early detection of risk factors. Blood glucose and systemic blood pressure monitoring play a key role in this issue. In addition, periodic determination of microalbuminuria is of particular importance, given its known value as an indicator of progressive renal and vascular disease. Once early stages of renal disease are diagnosed, simple procedures need to be put in place, again emphasizing lifestyle changes (reduction in sodium intake and other dietary indications) and early pharmacologic interventions that should include RAAS blockade and possibly other drugs such as low-dose aspirin or statins, if hyperlipidemia is present [43]. Validation of an educational program for primary physicians In spite of the availability of clear opportunities for intervention at almost any stage of diabetic nephropathy, preventive strategies are of very little or no impact, if the primary physician who is the first medical contact of the general community has limited knowledge about the natural history of diabetic nephropathy, the beneficial effect of early preventive maneuvers for delaying its progression, and the