The prevalence of type 2 diabetes is set to double over the next 25 years, leading to substantial morbidity and mortality, particularly from macrovascular diabetic complications. Pre-diabetic dysglycaemia, characterised by impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG), is associated with an increased risk of developing both type 2 diabetes and cardiovascular disease. IGT and IFG appear well before type 2 diabetes is diagnosed, thereby presenting an opportunity for intervention to reduce the future burden of diabetes and cardiovascular disease. Intensive lifestyle interventions are effective in preventing or delaying diabetes but are difficult to sustain long term. Intervention trials with pharmacological agents, e.g. the Diabetes Prevention Program (DPP) with metformin, and the STOP-NIDDM study with acarbose, have demonstrated significant decreases in the risk of progression to type 2 diabetes in populations with IGT. Moreover, preliminary evidence with these agents supports a possible beneficial effect on cardiovascular outcomes.