Diabetic nephropathy is a major underlying cause of morbidity and mortality in both type 1 and type 2 diabetes mellitus. It is strongly associated with cardiovascular disease, particularly heart failure, the incidence of which is about 15-fold greater in patients with diabetic nephropathy. All-cause mortality in patients with diabetic nephropathy is nearly 20–40 times higher than in patients without nephropathy. Many patients with diabetes, in particular type 2 diabetes, and renal impairment die from cardiovascular disease well before they progress to end-stage renal disease.