Native Americans, blacks, and other minorities are at high risk for diabetic renal failure, most of which is caused by non-insulin-dependent diabetes. Many of these patients receive care in publicly supported health programs. Recent evidence of the efficacy of hypertension control in slowing the decline in renal function and our ability to detect those at highest risk for renal deterioration with inexpensive microalbuminuria tests suggest major opportunities for concerted efforts to reduce the incidence of end-stage renal disease. Guidelines for management of high-risk patients are needed to translate effective management strategies into routine clinical practice.