What should we do to prevent diabetic kidney disease in high risk populations?

There is evidence of strong genetic and environmental factors that affect the development of diabetes and its complications including kidney disease and heart disease. Theories have been proposed to explain the increasing incidence of obesity, metabolic syndrome and diabetes in different racial groups. The most popular are the "thrifty genes", "drifty genes" or "thrifty phenotypes". Body fat distribution variations among different races have provided more information about racial variations related to metabolic syndrome and cardiovascular risk. There is an enormous amount of research trying to determine how these metabolic insults are translated into kidney damage and to cardio- vascular disease. There are many such mechanisms, hyperglycemia appears to upregulate the renin-angiotensin-aldosterone system, and this in turn damages the microvascular bed. So, given the rapid pace that the obesity, metabolic syndrome, diabetes epidemic is gaining in the world, inadequate treatments to forestall the development of diabetic kidney disease once it has started, together with our inability to adopt healthier life style, how could we prevent diabetic kidney disease? Should we turn our health care focus into prevention of obesity and target to individuals at high risk?