Diabetes mellitus is one of the major challenges to public health with global prevalence of 6.6% (285 million) and annual cost of 376 billion US dollars 13 Pharmacological and non pharmacological interventions which target either to delay the onset of diabetes or to prevent its complications have been the focus of clinical research. Recently, a double blind randomized controlled trial, CANOE (Canadian Normoglycemia Outcomes Evaluation), compared efficacy of a fixed- low-dose combination of rosiglitazone (2mg) and metformin (SOOmg) given twice daily against matched placebo . Time to the development of diabetes being the primary outcome measure the investigators reported a relative risk reduction of 66% (95 ❑ Cl 41-80] and the absolute risk reduction of 26% [14-37) in the treatment group. In addition, the only significant side effect observed in the treatment group compared with placebo was increase in diarrhea (16 [16%] vs 6 [6%]; p =0.0253). The trial design is unique as it is the first trial to use fixed low dose combination of rosiglitazone and metformin but certain issues in its design cannot be overlooked.