People with disturbed glucose metabolism are at an increased risk for cardiovascular disease. This risk starts before diabetes, according to present definitions, is established. Early detection of impaired glucose tolerance and target-driven multifactorial management incorporating all risk factors in a broad sense may effectively improve the prognosis for these persons. Management includes early detection of glucose perturbations and preventing or delaying future diabetes among people with impaired glucose tolerance. In people with established diabetes, hypertension, hyperlipidaemia and hyperglycaemia are all important factors to monitor and, if these are above the recommended levels, to treat, first hand with lifestyle-oriented recommendations, although usually supported by pharmacological interventions. Since impaired glucose tolerance and type 2 diabetes mellitus are rapidly increasing in the population, glucose perturbations as the cause of cardiovascular disease manifestations will become more common. Development of macrovascular complications substantially impacts care costs, and proper management of these individuals will therefore not only decrease personal suffering but also clearly impact health care expenditures.