Recently, the American Association of Clinical Endocrinologists (AACE) published new guidelines for the treatment of type 2 diabetes, integrating for the first time the control of obesity, prediabetes and cardiovascular risk factors. The new guidelines recommend addressing all threats to the diabetic patient. The new guidelines completely replace the 2009 guidelines for the treatment of diabetes and the 2008 guidelines for the treatment of prediabetes, where the old guidelines focused primarily on lowering sugar. Early and integrated is the main idea In the new guidelines, prediabetes treatment protocols emphasize cardiovascular risk factor control, giving both glucose-lowering treatment measures and providing obesity management strategies. Pre-diabetic people can consider the application of glucose-lowering drugs based on weight loss, with metformin and acarbose preferred, and if ineffective, thiazolidinediones (TZD) or glucagon-like peptide-(GLP-1) receptor agonists may be appropriate. For the first time, cardiovascular risk factor control has been integrated into diabetes treatment guidelines, including lipid-regulating and antihypertensive therapy, with the same goals and methods as previously recommended. Weight loss treatment is also included in the new guidelines as more and more studies have shown that weight loss through lifestyle modification, medication or surgery can help lower blood glucose. In fact, weight loss is the first line of treatment for prediabetes. The new guidelines emphasize a “comorbidity-centered” treatment model for managing overweight and obese patients. Those with a body mass index (BMI) ≥ 25 kg/m2 without comorbidities may be treated with lifestyle modification only. For those with BMI ≥ 25 kg/m2 and comorbidities, phentermine, orlistat, lorcaserin, or phentermine/topiramate extended-release tablets may be used for low- and intermediate-risk patients on the basis of lifestyle modification; for high-risk patients with BMI ≥ 35 kg/m2, bariatric surgery may be considered in addition to the above measures. Stratification of glycemic targets In previous guidelines, AACE recommended a target glycated hemoglobin (HbA1c) level of ≤ 6.5% for most patients with diabetes. The new protocol states that among patients with diabetes, those without comorbidities and at low risk of hypoglycemia should have a glycemic target of ≤ 6.5%; those with comorbidities such as cardiac arrhythmias or cerebrovascular disease and at high risk of hypoglycemia (on insulin or sulfonylureas, in the elderly) may have a target of higher than 6.5%, but should follow individualized principles. The old treatment guidelines determined the intensity of glucose reduction based on initial HbA1c levels, with lifestyle modification, including weight loss, hidden behind all treatment options. The new guidelines recommend that patients with HbA1c levels <7.5% be treated with one of the seven currently available classes of glucose-lowering medications.