Diabetes mellitus is a chronic metabolic disease of persistent high blood glucose due to the absence of insulin or the lack of its effects. The incidence has been rising rapidly in recent years, due to a number of modifiable and non-modifiable risk factors such as obesity, sedentary lifestyle, age and genetics. Timely management of the glucose levels through dietary modification, physical activity and pharmacotherapy is essential to achieve glycemic control and prevent complications of the disease. Type 1 diabetics need to use insulin therapy to maintain their glucose targets. Pharmacotherapy for type 2 diabetics includes oral anti-diabetics such as metformin, SGLT-2 inhibitors, GLP-1 agonists, DPP-4 inhibitors, TZDs and SUs. Metformin is the drug of choice for treatment in combination with lifestyle modification. Novel anti-diabetic drugs such as SGLT-2 inhibitors, GLP-1 agonists or DPP-4 inhibitors can be added to reach glycemic goals. There needs to be emphasis on drugs that have a weight reducing and cardioprotective effect, without provoking hypoglycemia. Choosing the right combination of drugs which are individualized to the patient, with flexibility for adjustments, helps ensure the target glycemic parameters are reached and maintained, decreases overall cardiovascular risk, prevents complications of the disease and improves quality of life.