The article reviews international recommendations for the prevention of type 2 diabetes. The recommendations are based on the results of several large-scale randomized clinical trials, including the Diabetes Prevention Program (DPP) and (DPPOS), the Finnish Diabetes Prevention Study (DPS) and the Diabetes Prevention Study (DaQing study), which demonstrate that lifestyle changes / behavioral therapy and the use of metformin are very effective methods of primary prevention of diabetes.According to the conclusions from the DPP study: the most effective way of primary prevention is an intensive lifestyle change, which mainly consists of reducing body weight> 7%, following a strict low-calorie diet with fat restriction and moderate physical activity lasting for 150 minutes per week. Patients' compliance (especially for a long time) with measures to intensively change their lifestyle is low. In a social environment, the implementation of this method is extremely difficult. It was noted that metformin proved to be as effective as intensive lifestyle modification in individuals under the age of 45 years with severe obesity (BMI ≥ 35 kg / m2). Thus, the author concludes: the patients' commitment to a set of measures aimed at changing their lifestyle is low. Metformin therapy leads to a stable reduction in the risk of diabetes. In addition, metformin, in accordance with the findings of the UKPDS study, reduces the risk of development of cardiovascular disease.