In case of newly diagnosed T2DM in elderly, it is difficult to change long-maintained eating habits. In the elderly, decreased appetite, unpredictable meal consumption and impaired swallowing can make antihyperglycemic therapy challenging. Common barriers to exercise in older adults include attitude, discomfort, disability, poor balance, fear of injury, habit, environmental factors, cognitive decline, illness/fatigue, etc. Metformin can be started with small dose, with dose increment every 7-14 days. Dipeptidyl peptidase-4 (DPP-4) inhibitors are efficacious with low hypoglycemia risk; are safe in chronic kidney disease (CKD). Insulin – Striking the balance: Basal insulin alone regimens are associated with less hypoglycemia and are easier to comply with; postprandial hyperglycemia (PPHG) calls for multiple preprandial insulin boluses in many elderly persons; twice-daily premixed regimen is less complicated and friendlier. Glycemic targets – Life expectancy >10 years: ≤7%; otherwise healthy with no or few comorbidities: <7.5%; chronically ill, cognitive impairment, functionally dependent: <8-8.5%; end of life: avoidance of hypoglycemia and hyperglycemia. Elderly people are at highest risk for hypoglycemia. Choice of drugs include metformin, DPP-4 inhibitors, AGIs, thiazolidinediones, and SGLT-2 inhibitors. Individualization of therapy is the key.