This clinical research study is enrolling adults with diabetes, prediabetes or metabolic syndrome. The purpose of the study is to learn more about preventing cardiovascular disease. A heart CT scan will be done at screening and then 2 years later. Qualified participants will be randomly assigned to one of two groups. Participants in the usual care group, will continue to receive care from usual health care provider. In the personalized care group, participants will receive additional health care from a remote cardiologist led team which will individualize treatment based on Cleerly CAD staging results of the heart CT scan. Study is expected to last 3 1/2 years on average but could be 2 - 5 years. Participation is free.