The growing scourge of diabetes mellitus is evident from steady rise in its prevalence which is already quite high.On the other hand, increase in life expectancy has lead to substantial rise in eldrly (>65years) population globally, more particularly so in developing nations.By 2050, China and India together will have about half a billion elderly.Management of a complex chronic disorder like diabetes mellitus in the elderly becomes a real challenge given the heterogenous health condition and multiple co-morbidities in the elderly.These factors also necessitates development of realistic and patient centered guidelines which look beyond the interventions that merely target the disease specific conditions, and adopt and rank the available intervention according to the input they are likely to have on the patients overall health outcome.The primary goal of managing diabetes in the elderly is to achieve euglycemia without causing hyperglycemia.Hence, tailoring of glycemic goal based on age, expectancy of life, presence of co-morbid condition specially of cardio-vascular origin is of paramount interest.Due to concomitant use of polypharrmacy to address co-morbidities, anti hyperglycemic drugs induced adverse event remains a potential risk.Changed pharmacodynamic and pharmakinetics in the elderly also exert their influenceon the overall impact of a drug.One has to strike the right balance between choosing the most appropriate agent, and avoiding or minimizing the risk of hypogycemia at the same time.Use of modern insulin and appropriate oral drugs such as incretins may help clinician to achieve this goal.