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The marked increase in new cases of type 2 diabetes observed throughout the world and the associated comorbidities represent one of the major health issues we will face in the 21st century. It is also understood that environmental factors such as lifestyle habits (i.e., physical inactivity and dietary intake) and obesity act as initiating factors for progression to type 2 diabetes. A number of studies have confirmed that intensive lifestyle modification is effective in the prevention of diabetes in individuals with impaired glucose tolerance (1,2). Although it is well established that caloric restriction and exercise greatly promote weight loss and improve insulin resistance for those at risk for developing type 2 diabetes, the success of lifestyle intervention over a long-term period is poor. Therefore, strategies to improve risk factors related to progression to type 2 diabetes, i.e., insulin resistance, by pharmacologic or nutritional supplementation represent a very attractive approach. In this regard, pharmacologic agents have shown efficacy in diabetes prevention, but adverse events need to be considered before routine use is recommended (3,4). In addition, other novel risk factors, e.g., homocysteinemia, have been associated with the development of type 2 diabetes, and cellular mechanisms have been postulated that provide an understanding for this effect (5). Until recently, however, there have been no prospective studies to evaluate whether nutritional interventions aimed at effectively treating homocysteinemia will reduce the chances for diabetes development. …

Primary Prevention of Type 2 Diabetes: There Are No Simple Solutions!