Diabetes is a major public health problem that is approaching epidemic proportions in our society and worldwide. Cardiovascular disease is the major cause of morbidity and mortality in people with diabetes. Control of cardiovascular disease risk factors is achieved only in a minority of patients. Given the magnitude of the problem and the seriousness of diabetes complications, prevention appears to be a logical approach to curb the rising prevalence of the disease. Interventions such as lifestyle modifications and the use of metformin and acarbose have been shown in randomized prospective trials to prevent diabetes in high-risk patients. Other interventions are currently being examined in large prospective studies. It is likely that one or a combination of these approaches will make diabetes prevention a reality in the near future.