Diabetes is becoming increasingly common in the elderly, affecting more than one person in five. In this group, type 2 diabetes is by far the more prevalent form. Despite this major public health concern, evidence-based information specific to older adults with diabetes is surprisingly lacking. Complicating the medical picture, the elderly commonly have a host of comorbidities that can influence diabetes treatment and therapeutic goals. Here, the authors present an overview of therapy, discussing the antidiabetic agents available and their best use in the older population with diabetes.