全球糖尿病人口逐年增加，隨著許多新型降血糖藥物及其心血管事件試驗陸續發表，國際各大第2型糖尿病治療指引在近幾年有大幅的更動：metformin第一線使用地位受到挑戰，而其他有心血管或腎臟保護實證的藥物逐漸受到矚目。這些藥物除了被點名優先使用，更在部分指引中進一步被列為第一線藥物。除了強調生活習慣調整和減重的重要性，藥物變革讓更早期的雙重藥物使用和更嚴格的血糖控制目標重新變得可行。如何兼顧良好的血糖控制、減少甚至預防併發症，同時保有可接受的副作用和體制可負擔之醫療費用，成為臨床醫師持續的挑戰。

The population of patients with diabetes has increased consistently worldwide. With the release of many new hypoglycemic drugs and publication of their cardiovascular outcome trials, the major guidelines for type 2 diabetes care have changed significantly in recent 2 years. The status of metformin as the first-line drug was challenged, while other drugs with evidence of cardiovascular or renal protection, such as glucagon-like peptide-1 receptor agonist or sodium-dependent glucose cotransporters-2 inhibitor are gaining attention, and even further listed as priority drugs in some guidelines. The importance of lifestyle modification and weight reduction were emphasized. Early dual therapy and stricter glycemic control goals have become viable again with new drugs. How to reach the good glycemic control, reduce or even prevent complications with acceptable side effects and affordable medical costs has become a continuing challenge for clinicians.