Recently, the American College of Clinical Endocrinologists (AACE) published new guidelines for the management of type 2 diabetes, integrating for the first time the control of obesity, prediabetes, and cardiovascular risk factors. (Endocr Pract. 2013, 19: 327) In the new guidelines, prediabetes treatment protocols emphasize cardiovascular risk factor control, giving both glucose-lowering treatment measures and obesity management strategies. Glucose-lowering medications may be considered in the prediabetic population on the basis of weight loss, with metformin and acarbose preferred and, if ineffective, thiazolidinediones (TZDs) or glucagon-like peptide-1 (GLP-1) receptor agonists as appropriate. For the first time, cardiovascular risk factor control has been integrated into diabetes treatment guidelines, including lipid regulation and antihypertensive therapy. The new guidelines state that the goal of glucose lowering for those without comorbidities and at low risk of hypoglycemia is an HbA1c level ≤ 6.5%; for those with comorbidities such as cardiac arrhythmia or cerebrovascular disease and at high risk of hypoglycemia, the goal of HbA1c control may be higher than 6.5%, but should be individualized. Glucose-lowering drugs considered relatively safe include: metformin, GLP-1 agonists, dipeptidyl peptidase 4 (DPP4) inhibitors and alpha glucoamylase inhibitors. Caution should be exercised when applying sodium-dependent glucose co-transport protein 2 (SGLT2) inhibitors, TZD and sulfonylureas. For patients whose blood glucose does not reach the target after 3 months of treatment with two or three drug combinations, the new guidelines recommend adding entero-insulin-based therapy such as GLP-1 agonists or DPP4 inhibitors, or optionally postprandial insulin, but the former is preferred.