The 66 ^th Scientific Sessions of the American Diabetes Association was held in Washington, D.C. (June 9–13, 2006). The meeting encompassed 5 days of presentations on topics related to the most recent advances in the treatment and prevention of diabetes. This convention report highlights the presentations that pertain to diabetes and cardiometabolic risk factors. Topics range from cellular pathways that regulate glycemic control to novel considerations on the endocannabinoid system to controversial issues on the metabolic syndrome. The report ends with a summary of a provocative debate on the diagnostic utility of the metabolic syndrome: is it a pragmatic tool to identify patients who need intensive therapy or is it a distracting algorithm without a purpose?