Over the past few years there have been several randomized controlled trials that examine the effect of lifestyle modification and pharmacological interventions on the likelihood of developing diabetes mellitus (DM) type 2 in people at high risk. These studies demonstrated that the number of people newly diagnosed with diabetes within 3–6-year period may be considerably reduced. Therefore focus of discussing the tactics to control DM type 2 is shifted from the relatively narrow topic of treatment of the disease at a wide range of issues of its prophylaxis: prevention of development and early treatment of DM, aimed to stabilization or reverse progression of the disease and prevention of its progression. This review discusses the general concept and the evidence base on preventing DM type 2 in the context of the pathogenesis of the disease. In addition, the attention is paid to the possibilities of the use of the discussed approaches to clinical practice, taking into account pathogenetic features of the disease and and clinical findings.