There are strong evidences that achieving goal of glycemic control is one of the most important things to prevent and delay diabetic complications. Recent several big clinical studies including ACCORD, VADT and ADVANCE made us focus on the limitations of medical treatment for type 2 diabetes. Hypoglycemia and weight gain are the serious and common barrier to achieve the goal of metabolic control. The clinical use of DPP-4 inhibitors has been increased explosively because they are lack of those limitations. The essential things in 2012 ADA/EASD guidelines are patient-focused approach and individualized treatment decision based on benefits and risk of management. We have to set an individualized goal after considering patient attitude, efforts, existing complications, risk of hypoglycemia, disease duration, life expectancy, comorbidities and support systems. Because of that, we should have evidences about safety and efficacy of DPP-4 inhibitors in various populations, even they showed less hypoglycemia and similar effectiveness in general. We will review several recent reports showed safety and efficacy of vildagliptin in special populations who are elderly, renal impairment and fasting etc. and discuss its implications in real clinical practice.