Background: The increasing incidence and prevalence of metabolic syndrome and type 2 diabetes mellitus (DM) have significant implications on health world-wide. Large clinical trials have demonstrated the effectiveness of a comprehensive lifestyle program with a goal of moderate weight loss (5–7%) and regular exercise (150 minutes/week), resulting in a significant decrease in the incidence of type 2 DM and cardiovascular risk.Methods: This study reports on the translation of the multi-center Diabetes Prevention Program (DPP) into a cardiac rehabilitation program, utilizing the expertise and experience of a cardiac rehabilitation program staff. The study adapted materials from the DPP to develop a program that fit local needs for diabetes prevention.Results: Most participants completed the program (11 months) and their moderate weight loss was maintained for 11–12 months. At 11–12 months, waist circumference was reduced by approximately 2 inches, percent body fat was reduced by 5% (11% relative decrease, p<.05), weight was decreased by 10.1 pounds (p<.05), and blood pressure was reduced 8/3 mm Hg (p<.05). Exercise, nutrition, glucose, triglycerides, LDL-cholesterol and HDLcholesterol were all were significantly improved at 11–12 months (p<.05).Conclusions: Efforts to improve lifestyle and reduce body weight are important to patients at risk of developing diabetes. This program demonstrates that an intensive effort can significantly improve lifestyle and reduce body weight in patients with DM or at risk for DM. A program that simulates cardiac rehabilitation, translated from a successful clinical trial into practice, resulted in significant reduction and improvement in metabolic outcomes and cardiovascular risk. Support for cardiac rehabilitation from insurers to develop similar programs is encouraged and deserves further study.