The American Diabetes Associations annual guidelines for 2018 include novel recommendations for use of glucose-lowering drugs with proven cardiovascular benefit in type 2 diabetes, optimization of diabetes care in elderly patients, and glucose screening of high-risk adolescents. The most impactful new recommendation necessitates the use of a glucose-lowering agent with proven cardiovascular benefit, such as the glucagonlike peptide 1 (GLP-1) agonist liraglutide, and/or mortality reduction, such as that observed with the sodium glucose cotransporter-2 (SGLT2) inhibitor empagliflozin, in type 2 diabetes patients with established atherosclerotic cardiovascular disease (ASCVD) who fail to achieve glycemic targets with lifestyle modification and metformin. The ADA 2018 Standards of Medical Care in Diabetes are published online December 8, 2017 in Diabetes Care.