As the epidemic of type 2 diabetes continues to grow, efforts to define effective diabetes prevention strategies are gaining momentum. Although lifestyle interventions have consistently been shown to reduce diabetes incidence, difficulties with long-term adherence and contraindications owing to concomitant morbidity associated with diabetes make pharmacological prevention strategies an attractive option. Oral antidiabetic agents, antiobesity agents, lipid lowering drugs, and antihypertensive medications have all been implicated in diabetes prevention. However, few studies have provided sufficient follow up to determine if noted reductions in diabetes incidence associated with the agents represent prevention or delay of the disease. Additionally, whether reducing diabetes incidence will subsequently translate to lasting benefits in morbidity and mortality remains unclear.