The incidence of type 2 diabetes is increasing throughout the world resulting in a huge growth in demands on health services. Despite advances in treatment, complications still occur. Prevention of type 2 diabetes or delaying its onset is therefore a desirable goal. In trials, lifestyle measures have been partially successful but continuing adherence is difficult. A number of drugs have been tried with varying success. Those people who develop type 2 diabetes have been found to have a more atherogenic lipid profile and to be more insulin resistant, than those who do not, and at increased cardiovascular risk. Fibrates, which are safe and cheap, could help to correct these abnormalities at an early stage and reduce cardiovascular risk. They would seem a suitable option for prevention of type 2 diabetes. Evidence is presented to suggest that the fibrates, in particular bezafibrate, could have a role in prevention of type 2 diabetes in those at high risk and that a randomised trial would seem justified.
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