The potential to prevent type 2 diabetes in high-risk individuals by lifestyle intervention was established in several clinical trials. These studies had a strong focus on increased physical activity and dietary modification as well as weight reduction among overweight participants. The key issue seems to be a comprehensive approach to correct several risk factors simultaneously. Furthermore, long-term follow-up studies of lifestyle interventions lasting for a limited time period seem to have a long-lasting carry-over effect on risk factors and diabetes incidence (Table 1). The research evidence has inspired national and local authorities and health care providers all over the world to start programs and activities to prevent type 2 diabetes and its complications. Based on the experiences from the clinical trials, as well as from the “real world” implementation programs, the IMAGE (Development and Implementation of a European Guideline and Training Standards for Diabetes Prevention) Study Group collated information in a systematic manner. The IMAGE deliverables include a European evidence-based guideline for the prevention of type 2 diabetes, a toolkit for the prevention of type 2 diabetes in Europe, and the quality indicators for the prevention of type 2 diabetes in Europe. What is needed now is political support to develop national action plans for diabetes prevention. The prerequisites for successful prevention activities include involvement of a number of stakeholders on the governmental and nongovernmental level as well as on different levels of health care. Furthermore, structures to identify high-risk individuals and manage intervention, follow-up, and evaluation have to be established. Observational studies have provided firm evidence that multiple lifestylerelated factors either increase or decrease the risk of type 2 diabetes. Thus, in type 2 diabetes prevention, it is important to pay attention not only to one single factor such as obesity but also to several factors simultaneously. This method was unequivocally demonstrated by the Finnish Diabetes Prevention Study (DPS), where none of the high-risk individuals with impaired glucose tolerance (IGT) developed diabetes during the initial trial period if they reached four or five out of five predefined lifestyle targets (1). These targets were as follows: weight loss. 5%, intake of fat, 30% energy, intake of saturated fats, 10% energy, increase of dietary fiber to $15 g/1,000 kcal, and increase of physical activity to at least 4 h/week. Such targets are relatively modest and therefore possible to reach by many people. Moreover, to practice such a lifestyle is feasible for the long term, even for an entire lifetime. However, the trial data have been criticized for presenting an over-optimistic outlook, since the trial population comprised individuals who volunteered to participate in such a lifestyle intervention trial. It has been questioned whether or to what extent such trial results can be translated to the general population. Although this critique may be valid, the individuals participating in the trial were typical Finnish people with IGT who were overweight, were relatively sedentary, and whose diet was discordant with recommendations in many ways (2). To provide evidence about the effects of a healthy lifestyle in the general population, a prospective cohort study was recently carried out among older US adults (3). The particular aim of the study was to evaluate the association of multiple lifestyle factors, including physical activity level, dietary habits, smoking habits, alcohol use, and adiposity measures, with risk of new-onset type 2 diabetes. Each factor was independently associated with diabetes, but in combination, these lifestyle …