The increasing prevalence of metabolic syndrome has created an impetus to prevent complications such as diabetes. There are no defined treatments for metabolic syndrome apart from addressing each of its components such as obesity, hypertension, dyslipidemia, and hyperglycemia. To evaluate diabetes-prevention strategies, we performed a Medline search and identified evidence suggesting that lifestyle intervention and certain medications can prevent diabetes. In addition, there are several agents on the horizon that seem promising. The mechanism responsible for diabetes prevention relates to improved insulin resistance as a result of weight loss or other processes. Lifestyle interventions and medications such as metformin are effective and safe in long-term prevention studies. However, the safety and efficacy of newer agents need clarification.