The last 50 years has witnessed the recognition of type 2 diabetes as a complex heterogeneous disease that results from an interaction between environmental factors and genetic predispositions. As its pathophysiology has been unfolded by the advances in clinical science, so its prevalence has increased dramatically, and it is now one of the major personal and public health problems worldwide. Therapeutic approaches to address insulin resistance and beta-cell dysfunction have intensified and diversified during the last decade, driven by indisputable evidence that the treatment goals include both glycaemic control and attention to all vascular risk factors. Advances in basic and clinical research over the last fifty years have culminated in sufficient strategies and pharmacological agents to start to achieve these goals. Equally as important, they have laid the foundation for what promise to be remarkable future developments.