A growing diabetes pandemic is unfolding with rapid increases in the prevalence of type 2 diabetes, which affects more than 530 million adults in 2021 globally. In South-East Asia, 1 in 11 adults (90 million) are living with diabetes, and the number of adults with diabetes is expected to exceed 110 million by 2030. Diabetic complications constitute the leading causes of morbidity and mortality for individuals with diabetes. Since 1990s large-scale clinical trials have demonstrated that intensive glycaemic control reduced the risk of developing microvascular (and, to a lesser extent, macrovascular) complications, and they were no longer considered inevitable. Therefore, the aim of diabetes management was shifted from sustaining life and relieving hyperglycaemic symptoms, to preventing diabetic complications through optimizing glycaemic status and cardiovascular risk factor control. However, diabetic patients are still at excess risk despite standard care. In recent years, two new classes of anti-diabetic agents, namely sodium-glucose co-transporter 2 inhibitor (SGLT2i) and glucagon-like peptide 1 receptor agonist (GLP1Ra), have demonstrated remarkable cardiovascular and kidney protection independent of effective glucose control, and they have been incorporated into the latest international guidelines on diabetes management, which emphasize a risk-based approach to choosing anti-diabetic agents. The benefits, risks and precautions, and the practical tips on applying these new agents in diabetes management will be illustrated in clinical case presentations.
