Currently there are several classes of agents available for the management of type 2 diabetes including biguanides (metformin), sulphonylureas, the alpha-glusosidase inhibitor acarbose, thiazolidinediones, DPP-4 inhibitors, GLP1 receptor agonists, SGLT2 inhibitors and of course a wide variety of insulins. Several of these agents can be used in combination therapy. The different classes of agents and even some different drugs within classes have various side-effect profiles and as such treatment can be tailored to suit the individual patient’s needs. Safe and effective therapy can now be prescribed in consultation with the patient with the aim of minimising side-effects such that “bespoke” diabetes therapy can be administered to the individual. In this way, pharmacotherapy offers benefits over and above lifestyle therapy and with a lower side-effect profile than surgery. The pros and cons will be discussed during this debate.