The global epidemic of type 2 diabetes (T2DM) continues largely unabated due to 
an increasingly sedentary lifestyle and obesogenic environment. A cost-effective 
patient-centred approach, incorporating glucose-lowering therapy and 
modification of cardiovascular risk factors, could help prevent the inevitable 
development and progression of macrovascular and microvascular complications. 
Glycaemic optimization requires patient structured education, self-management 
and empowerment, and psychological support along with early and proactive use of 
glucose lowering therapies, which should be delivered in a system of care as 
shown by the Chronic Care Model. From diagnosis, intensive glycaemic control and 
individualised care is aimed at reducing complications. In older people, the 
goal is maintaining quality of life and minimizing morbidity, especially as 
overtreatment increases hypoglycaemia risk. Maintaining durable glycaemic 
control is challenging and complex to achieve without hypoglycaemia, weight gain 
and other significant adverse effects. Overcoming patient and physician barriers 
can help ensure adequate treatment initiation and intensification. 
Cardiovascular safety studies with newer glucose-lowering agents are now 
mandatory, with a sodium glucose co-transporter-2 inhibitor (empagliflozin), and 
two glucagon like peptide-1 receptor agonists (liraglutide and semaglutide) 
being the first to demonstrate superior CV outcomes compared with placebo.