The priority in modern diabetes management is not only optimizing glycaemic control but addressing the major causes of morbidity and mortality, its cardiovascular and renal complications. The advent of new glucose lowering agents which are associated with end organ protection provides clinicians with an opportunity to make a major impact on the progression on the prognosis of diabetes. For example the recent EMPA-REG OUTCOME study has identified a new approach to reduce not only cardiovascular but also renal complications using SGLT2 inhibition. The recent LEADER study has suggested that GLP-1 agonism may also confer benefit in a diabetic population. Over the next few years as more clinical data accumulate, more rationale strategies will develop into appropriate revised guidelines for the management of diabetes. Finally recent advances in the genetics of diabetes and its complications will leads to new biomarkers and treatments for diabetes and associated cardiovascular and renal disease.