The prevalence as well as the incidence of diabetes mellitus has been increasing worldwide. In an aging society, this disorder in older adults contributes to these increases. Older people are more vulnerable than younger people to developing excessive fat deposition and reduction in skeletal muscle because of a sedentary lifestyle, lower energy expenditure, and physical alterations due to aging, which can lead to the development of insulin resistance. The capacity of pancreatic beta cells to regenerate and differentiate is reduced in older people, which predisposes them to insulin deficiency. These two pathophysiological alterations underlie the development of glucose intolerance. With significantly longer life spans thanks to the advances in health care, it is imperative to attain optimal glycemic control in this specific population to prevent diabetes-related chronic complications. In addition to life style modifications such as dietary control and exercise for obese patients and those who could benefit from moderate weight loss, antidiabetic agents are frequently required to achieve prespecified treatment goals. Delivery of these medications in an efficient and safe manner must be tailored to individual requirements to maintain an intricate balance between reasonable glycemic control and hypoglycemia. Older adults with diabetes are vulnerable to hypoglycemia due to a long history of the disease and frailty from aging. As long as factors that impact the pharmacokinetics and pharmacodynamics of these agents are considered, such as renal function and adherence to polypharmacy, oral agents are more welcomed by older people because of convenience of administration and proved clinical efficacy. When oral agents fail, insulin therapy may be unavoidable when trying to pursue an optimal glycemic target.