A recent health survey from the Cleveland Clinic revealed that more people thought that kidney disease was the leading cause of death for people with diabetes than any other cause. Heart disease is clearly the leading cause of death for people with diabetes, and the rates of kidney disease continue to fall. Kidney International today published 21 year follow-up data on the Steno-2 trial, which was one of the first trials to look at the effect of intensive treatment of blood pressure and lipids along with glycemia in the prevention of diabetes-related complications. Fewer than 10% of their study group developed end-stage kidney disease, and the group that received initial intensive treatment had over a 40% reduction compared to the standard treatment group. This is impressive since the intensive treatment occurred over a mean duration of 7.8 years, after which both intensive and control groups received the same treatment. A reminder that starting early always helps, and that complication rates in people with diabetes continue to decrease.