In the past fifteen years, the understanding of, and the chain of events leading to type 2 diabetes and cardiovascular disease has greatly expanded. This was largely due to the introduction of the Insulin Reisistance Syndrome. It has now been recognized that almost 1 in 3 adults in the United States may have the Insulin Resistance Syndrome—of these, some of will go ahead to develop type 2 diabetes, but the majority (though diabetes free) will be at higher risk for cardiovascular disease and other metabolic consequences.