Like other countries in the Western Pacific region, Thailand is facing increasing numbers of patients with diabetes due to unhealthy diets, high obesity rates, and an aging society. Diabetes is a considerable burden for developing countries as it reduces quality of life, increases mortality, and drives up healthcare costs. The disease detection rate in Thailand has improved in recent years, but glycemic control remains suboptimal and significant numbers of patients suffer from complications. Universal healthcare coverage has increased access to care, but inequality exists between different health plans and non-medication diabetes supplies are not yet widely covered. Diabetes self-management education has not yet been standardized and a multidisciplinary team approach is not widely utilized. The Thai government recognizes the burden of diabetes and has launched nationwide programs of health promotion and disease prevention. In addition, local initiatives have targeted reductions in specific complications, including retinopathy and diabetic foot problems, which has resulted in better disease prevention and treatment. Along with strategic public health planning, increased collaboration between private and public sectors, enhanced professional training, increased use of technology and data management, and equitable distribution of care are all needed to improve outcomes of patients with diabetes in Thailand. Cardiovascular disease (CVD) events are a major problem in people with diabetes, contributing considerably to morbidity and mortality. However, the pattern of disease has changed with less myocardial infarction (MI) and more hospitalization for heart failure. Although glucose levels are strongly associated with CVD, reduction in glucose alone does not reduce CVD. However, it has long been hypothesized that the individual drugs used to lower glucose may have a role in reducing events. For example, metformin reduced MI and mortality in the UKPDS. The insulin sensitizer pioglitazone reduced some events, particularly recurrent stroke, in PROACTIVE - later confirmed in IRIS. Some controversy arose with misinterpretation of data on rosiglitazone resulting in an FDA mandate to demonstrate CVD safety in all new diabetes medications. Most of these trials were designed to demonstrate safety and this was demonstrated with DPP- 4 inhibitors, including trials in high risk patients. Trials with SGLT2 inhibitors have demonstrated a marked relative risk reduction in hospitalization for heart failure (CHF) and progression of chronic kidney disease (CKD), with some effect on other CVD events, including mortality. In contrast trials, with GLP-1 receptor agonists (GLP_1 RA) have demonstrated a reduction in a range of CVD events but not heart failure Results of these trials have led to a significant change in guidelines for managing hyperglycemia with more precise individualization. The guidelines recommend evaluation for the presence of CVD or CKD or CHF and then starting therapy based on clinical trial results. Other considerations may still drive choice of other agents such as prevention of stroke with a TZD or avoiding hypos with a DPP-4 inhibitor or using a sulfonylurea where cost is an issue. These recommendations are being rapidly deployed in practice allowing the development of precision medicine in diabetes.