Background Type 2 diabetes mellitus is a public health concern, and projections of its future effect are alarming. According to the World Health Organization, diabetes affects more than 170 million people worldwide, and this number will rise to 370 million by 2030 [1]. About one third of those affected will eventually have progressive deterioration of renal function [2, 3]. The first clinical sign of renal dysfunction in patients with diabetes is generally microalbuminuria (a sign of endothelial dysfunction that is not necessarily confined to the kidney)[4], which develops in 2 to 5 percent of patients per year [5,6]. In type 2 diabetes, unlike type 1 diabetes [7], microalbuminuria is seldom reversible [8], but, instead, progresses to overt proteinuria in 20 to 40 percent of patients.[9,10]. In 10 to 50 percent of patients with proteinuria, chronic kidney disease develops that ultimately requires dialysis or transplantation [11,12,13]. Forty to 50 percent of patients with type 2 diabetes who have microalbuminuria eventually die of cardiovascular disease [14,15]; this is three times as high a rate of death from cardiac causes as among patients who have diabetes but have no evidence of renal disease [6].