In this paper, Tuomilehto reviews the current evidence regarding non-pharmacological approaches in the prevention and early treatment of type 2 diabetes. Type 2 diabetes is a very expensive and slow process disease that involves both genetic and environmental components. Several randomized controlled trials have now provided compelling evidence that type 2 diabetes can be prevented or delayed by lifestyle modification programs. In fact, individuals with impaired glucose tolerance can reduce their risk of developing type 2 diabetes by about 50% when compared to those allocated to usual care. Thus, lifestyle management should have a key role in type 2 diabetes management and prevention.