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The best way to prevent CV complications in diabetes is to prevent the disease itself. Several studies performed over the last decade have shown that, in subjects at high risk for development of diabetes, lifestyle modifications and pharmacologic interventions may effectively prevent or delay the onset of the disease. Regular physical activity, diet, and weight reduction in high-risk subjects with IGT were shown to reduce the risk of developing diabetes by 31% to 58%. Several drugs also were able to reduce the progression from IGT to diabetes. The risk of developing diabetes decreased with metformin by 31% over 2.8 years, with acarbose by 25% over 3.5 years, with tro-glitazone in women with a history of gestational diabetes by 56% over 5 years, and with orlistat in obese subjects with IGT by 45% over 4 years. Finally, the Diabetes REduction Assessment with ramipril and rosiglitazone Medication (DREAM) trial recently showed that rosiglitazone, administered for 3 years, reduced the incidence of diabetes by 62% in middle-aged adults (N = 5269) with IFG, IGT, or both.142

The authors would like to acknowledge Ms. Karin Zambelis for providing assistance with graphics.

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