Native Americans (American Indians and Alaska Natives) have a greater chance of having diabetes than any other US racial group. Diabetes is the leading cause of kidney failure, a costly condition that requires dialysis or kidney transplant for survival. Kidney failure can be delayed or prevented by controlling blood pressure and blood sugar and by taking medicines that protect the kidneys. Good diabetes care includes regular kidney testing and education about kidney disease and treatment. Kidney failure from diabetes among Native Americans was the highest of any race. However, this has declined the fastest since the Indian Health Service (IHS) began using population health and team-based approaches to diabetes and kidney care, a potential model for other populations.