This invention relates to methods and compositions for the prevention and treatment of Type 2 diabetes and cardiovascular disease with diabetic or pre-diabetic conditions or symptoms associated therewith using both a PPAR gamma agonist and a PPAR alpha agonist or a compound which activates both PPAR gamma and PPAR alpha . A preferred PPAR gamma agonist is a thiazolidinedione compound, including BRL 49653, troglitazone, pioglitazone, ciglitazone, WAY-120,744, englitazone, AD 5075, darglitazone, and congeners, analogs, derivatives and pharmaceutically acceptable salts thereof. A preferred PPAR alpha agonist is a fibrate compound including gemifbrozil, fenfibrate, bezofibrate, clofibrate, ciprofibrate, and analogs, derivatives and pharmaceutically acceptable salts thereof