For most of the last hundred years, the management of diabetes has been focused on achieving and maintaining optimal control of plasma glucose levels. Studies like UKPDS (2000) clearly demonstrated that the lower the cumulative exposure to elevated glucose levels, the lower the risk of diabetic complications, including eye, kidney, foot and heart disease. However, once complications develop, glucose control and standard of care is not enough, and other interventions are needed to change hard outcomes. In particular, recent large cardiovascular outcome trials have demonstrated that SGLT2 inhibitors are able to reduce major acute cardiovascular events (MACE), hospitalisation for heart failure and the development and progression of impaired kidney function. Some studies have also demonstrated benefits on patient survival. In addition, trials with some GLP-1 receptor agonists have also demonstrated reductions in MACE outcomes. This new evidence has resulted in changes in drug indications as well as global guidelines for diabetes management, which now recommend prioritising these agents in patients with or at high risk for complications. And in the future, these agents will likely become a foundational part of modern diabetes management, as the cost implications of preventing of diabetic complications far outweighs the cost of medication to prevent them.