The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a joint task force to examine the evidence and develop recommendations for anti-hyperglycemic therapy in type 2 diabetes. Several guideline documents have been developed by members of these two organizations and by other societies and federations. These new recommendations are less prescriptive than and not as algorithmic as prior guidelines. The intent of this recommendation is to encourage an appreciation of the variable and progressive nature of type 2 diabetes, the specific role of each drug, the patient and disease factors that drive clinical decision-making and the constraints imposed by age and co-morbidity. Glycemic targets of anti-hyperglycemic therapy were designed to reduce the incidence of microvascular complications. HbA1c is targeted to < 7.0% achieved with a mean plasma glucose of ~150-160 mg/dL; ideally, fasting and pre-meal glucose maintained at < 130 mg/dL and the postprandial glucose at < 180 mg/dL. However, individualized target is key point of these recommendations according to the degree of disease duration, life expectancy, important comorbidities, established vascular complications, patient support system, and hypoglycemia or other adverse effects of treatment. Lifestyle interventions are critical parts of type 2 diabetes management and designed to impact an individual’s physical activity levels and food intake. Metformin, if not contraindicated and if tolerated, is the preferred and most cost-effective first agent. If metformin cannot be used, another oral agent could be chosen, such as a sulfonylurea/glinide, pioglitazone, or a DPP-4 inhibitor; in occasional cases where weight loss is seen as an essential aspect of therapy, initial treatment with a GLP-1 receptor agonist might be useful. And monotherapy alone does not achieve/maintain an HbA1c target over ~3 months, the next step would be to add a second oral agent, a GLP-1 receptor agonist or basal insulin. Notably, the higher the HbA1c, the more likely insulin will be required. Triple combination therapy of anti-hyperglycemic agents can be tried in patient without achieving the glycemic targets, but these patients should be monitored closely, with the approach promptly reconsidered if it proves to be unsuccessful. The degree of hyperglycaemia (e.g. ≥ 8.5%) makes it unlikely that another drug will be of sufficient benefit, and prompt change to insulin should be considered.