Keeping your kidneys healthy could be one of the best ways to extend your life if you have diabetes, researchers have suggested.
The University of Washington study found that having kidney disease meant a much higher risk of early death.
UK experts say that the NHS is still not putting enough effort into detecting and controlling kidney problems caused by diabetes.
Figures from 2012 suggest only seven in 10 patients get vital annual checks.
Approximately 5% of people in the UK have been diagnosed with diabetes, and careful management of their condition through a combination of medication and lifestyle changes can mean it has relatively little impact on their lives.
However, if the disease has been present for some time prior to diagnosis, or is poorly managed afterwards, the risk of life-changing complications rises.
These include eye and lower limb problems, and kidney problems.
The research, in the Journal of the American Society of Nephrology, looked at mortality rates over a 10-year period in more than 15,000 adults, with and without diabetes.
Kidney disease was present in 9.4% of the people without diabetes, and 42.3% of those with diabetes.
They found that 7.7% of those without diabetes or kidney disease died over the course of the decade-long study.
This rose to 11.5% for people with diabetes but no kidney disease, but soared to 31.1% for people with diabetes and kidney disease.
Lead researcher Dr Maryam Afkarian said: “People with type-two diabetes have many other risk factors for cardiovascular disease and mortality, so we expected that kidney disease would predict a part, but not a majority, of higher mortality.”
Singling this group of patients out for intensive treatment, or working harder to prevent kidney disease from taking hold, could be a powerful way of reducing deaths among people with diabetes, she added.
Cathy Moulton, a clinical adviser at Diabetes UK, said that if detected early, diabetic kidney disease could be controlled using blood pressure medication.
However, the charity’s 2012 report found that as many as three in 10 patients were missing out the simple blood or urine tests that would reveal their kidney problems.
She said: “There really is no excuse for this – there is clear guidance saying that kidney function should be tested.