Diabetes Prevention Program Pilot Study

Inclusion Criteria: * Age \>18 years * BMI \>24 kg/m2 (\>22 kg/m2 among Asian Americans) * IGT (2-h plasma glucose 140\~199 mg/dl based on 75-g OGTT if available). The OGTT will not be required for inclusion, but the CMA practitioners may wish to recommend the OGTT for their patients. * Elevated FPG (95\~125 mg/dl\*). * HDL-triglyceride ration \> 3.5. Exclusion Criteria: * Diabetes at baseline * FPG \>126 mg/dl\* * 2-h plasma glucose \>200 mg/dl based on 75-g OGTT, if available. OGTT will not be required (see above note). * Diabetes diagnosed by a physician and confirmed by other clinical data, other than during pregnancy. * Ever used antidiabetic medication, other than during pregnancy * Medical conditions likely to limit life span and/or increase risk of intervention * Cardiovascular disease * Hospitalization for treatment of heart disease in past 6 months New York Heart Association Functional Class\> 2 * Left bundle branch block or third degree AV block Aortic stenosis * Systolic blood pressure\> 180 mmHg or diastolic blood pressure\> 105 mmHg * Cancer requiring treatment in the past 5 years, unless the prognosis is considered good * Renal disease (creatinine GFR \< or = 30 ml/hr or \> 2.0 mg/dl if GFR not available). * Anemia (hematocrit \<36% in men or \<33% in women) * Hepatitis (based on history or serum transaminase elevation) * Other gastrointestinal disease (pancreatitis, acute inflammatory bowel disease) * Recent or significant abdominal surgery * Pulmonary disease with dependence on oxygen or daily use of bronchodilators * Chronic infection (e.g., HIV, active tuberculosis) * Conditions or behaviors likely to affect conduct of the trial * Unable to communicate with clinic staff (e.g., read and speak English). * Unwilling to accept treatment assignment by randomization * Participation in another intervention research project that might interfere with DPP * Weight loss of \> 10% in past 6 months for any reason except postpartum weight loss * Unable to walk 0.25 miles in 10 min * Currently pregnant or within 3 months postpartum * Currently nursing or within 6 weeks of having completed nursing * Pregnancy anticipated during the course of the trial * Unwilling to undergo pregnancy testing or report possible pregnancy promptly * Unwilling to take adequate contraceptive measures, if potentially fertile * Major psychiatric disorder, including severe active major depression, severe anxiety, schizophrenia, manic depression, bi-polar disorder * Excessive alcohol intake, either acute or chronic * Medications and medical conditions likely to confound the assessment for diabetes including: * Niacin, in doses indicated for lowering serum triglycerides * Glucocorticoids, systemic * Other prescription weight-loss medications * Active Thyroid disease, suboptimally treated as indicated by abnormal serum thyroid-stimulating hormone * Other endocrine disorders (e.g., Cushing's syndrome, acromegaly) * Fasting plasma triglyceride \>600 mg/dl, despite treatment