Other factors, such as adiponectin and resistin, showed to have a role in glucose metabolism. Adiponectin, a protein produced by adipocytes, has well-known anti-inflammatory and anti-atherogenic actions, and it is postulated to improve insulin sensitivity through the improvement of carbohydrates and lipids metabolism. In contrast, resistin seems to induce insulin resistance and decreased glucose tolerance. Thus, the improvement of metabolic syndrome, by means of an increase of insulin sensitivity and correction of correlated lipids and carbohydrates metabolism may play a primary role in the prevention of type 2 diabetes and, in the long term, may decrease micro- and macro-vascular complications. Large prospective trials will help us to understand cellular mechanisms involved in metabolic syndrome and may be useful to identify new therapeutic targets aimed to reduce insulin resistance. Carnitine is involved in lipids and carbohydrates metabolism and acetyl-L-carnitine (ALC) may increase glucose utilization in type 2 diabetic patients, possibly restoring the glycogen synthase activity. ALC is a mitochondrial carrier of acylic groups, which directly and indirectly participates to carbohydrates metabolism, acting on fatty acids and on glucose oxidation on pyruvate dehydrogenase (PDH). PDH is formed by an enzymatic complex (PDC) which catalyzes an irreversible reaction in carbohydrates oxidation, and it is controlled by a phosphorylation-dephosphorylation cycle, in which Pyruvate Dehydrogenase Kinase uses ATP to phosphorylate PDH causing its inactivation, and Pyruvate Dehydrogenase Phosphatase dephosphorylates PDH inactivating it. Kinase is activated by an increased ratio intramitochondrial acetylCoA/CoA, as we can see in conditions of high fatty acid levels. The consequent reduction of PDC activity, dramatically decreases glucose oxidation. Carnitine participates to trans-esterification, forming acetylcarnitine. By means of catching acylic groups, it decreases ratio acetylCoA/CoA, indirectly stimulating PDC activity and favouring pyruvate oxidation and of glucose. Thus acetylcarnitine can be considered a modulator of substrates utilization in cells, with consequences in the metabolism of both lipids and carbohydrates. Several studies demonstrated that carnitine contributes to the improvement of insulin sensitivity and glucose utilization in both healthy subjects and type 2 diabetics. Thus it is interesting to confirm the hypothesis that acetylcarnitine may improve insulin sensitivity in patients with a risk for type 2 diabetes and verify if this improvement is associated with other components of metabolic syndrome.